ACL Tears: Life Before, During and After

An ACL injury can change everything in an instant. For athletes, it may mean a lost season and a long road to recovery. For non-athletes, it can cause instability during everyday activities, such as exercise or even using stairs. At Orthopedic ONE, our orthopedic and sports medicine surgeons, including Dr. Jason Ferrel and Dr. Ryan Blackwell, care for patients across the spectrum of activity levels, helping them understand what an ACL injury really means and how to move forward with confidence.

Understanding an ACL Tear

“The ACL is a ligament in your knee, so it’s a band of tissue that holds the bones and limits their movement,” Dr. Ferrel explains. “When you tear that band of tissue, it no longer restricts movement in the knee the way it should, making the knee feel unstable.” Without that stability, patients’ knees may give out, whether during competitive sports or everyday movements.

This instability can also lead to further problems. When the knee moves abnormally, other structures, such as the meniscus and cartilage, are more vulnerable to damage, which can affect long-term knee function if left untreated. This is why the ACL is often considered the “primary stabilizing ligament of the knee,” says Dr. Blackwell. “It really is an essential structure for knee health and knee stability.”

Risks and Rising Injuries

Unfortunately, certain demographics are at a much higher risk of ACL injuries. “Studies have shown that young female athletes tear their ACLs at a rate of at least three times higher than male athletes, especially in their teenage years,” Dr. Blackwell explains.

“The patient that keeps someone like me up at night is a young female athlete who frequently cuts and pivots,” agrees Dr. Ferrel. “They’re at the highest risk, and it’s not even close.”

Sports such as soccer, volleyball, basketball, and lacrosse place repeated stress on the ACL due to frequent jumping and changing direction. However, ACL injuries are rarely caused by contact and are not limited to competitive athletes. Adults can experience ACL tears during recreational activities, low-intensity sports, and even awkward falls.

Previous ACL injuries can also increase the likelihood of another tear. Additionally, while some people naturally have safer mechanics, especially when it comes to cutting, jumping, and landing, Dr. Ferrel emphasizes, “there’s definitely an educational or training component to it.” In other words, technique is important to reduce injury risk, and it can be taught.

Both physicians agree that ACL injuries have been on the rise over the last 20 years, and not just because MRIs have become more common. “We have more youth participating in sports,” Dr. Ferrel says, “which is great, but they’re not only starting sports at a younger age, they’re beginning to specialize early on, too.” Specialization often comes with year-round play, limited breaks, and repetitive movements, all of which can strain the body and the ACL.

Dr. Blackwell points to another factor: “the speed of play and the intensity of sports, even at the youth level, is much higher than what it used to be.” These trends have created an environment where ACL injuries are more likely, particularly among developing athletes, but increasingly in adults as well.

Prevention Tactics and Treatment Options

While it’s impossible to completely eliminate ACL injuries, “the goal is to lower the risk as much as possible,” Dr. Blackwell explains. One of the most effective ways to do so is through the FIFA 11+ warm-up guide. FIFA 11+ optimizes neuromuscular training to help athletes learn and execute proper movement mechanics. “It’s a very structured, 10-20 minute warm-up that can be incorporated by coaches, teams, and even individual athletes before every training session.” Not only is this a highly studied and highly effective routine, but it’s also free. “The only cost of this program is time,” adds Dr. Ferrel, which seems well worth it considering “some literature claims this program reduces the rate of ACL tears by 50 percent.”

Beyond intentional ACL-focused warm-ups, limiting early sport specialization, taking short and long-term breaks, and focusing on hip and core strength can all help lower the risk of injury. For non-athletes, consistent strength and balance training can improve knee stability and help prevent fall-related injuries.

When an ACL injury does occur, treatment is not one-size-fits-all. Surgery is often recommended for athletes who want to return to sports or for those with an active lifestyle. As Dr. Ferrel advises, “finding a surgeon that you can communicate with and that you trust will help you sort through the complex details and nuances of an ACL surgery.” However, “not everyone needs surgery,” he stresses. For individuals who primarily walk, only engage in low-impact exercise, or remain fairly stable despite the injury, physical therapy may be sufficient. “We cater the treatment to each patient individually,” explains Dr. Blackwell, “ensuring every patient can choose their own path forward.” 

Recovery and Rehabilitation at Orthopedic ONE

For patients who undergo ACL reconstruction, recovery usually takes about nine to 12 months. However, the return-to-play protocol is guided by a criteria-based progression rather than a fixed timeline. This ensures the ACL has time to complete the ligamentization process and regain strength and functionality.

Professional athletes, including players from the Columbus Crew, where Dr. Blackwell serves as a team physician, follow the same medical principles. “The rehab between professional and amateur youth athletes is actually quite similar,” Dr. Blackwell explains. There are no secret programs or quick-fix recovery tactics. “The only real difference is the amount of time professional athletes have to dedicate to their rehab and recovery.”

That said, physical therapy is crucial to every recovery path and long-term success. Dr. Ferrel and Dr. Blackwell both drove this sentiment home, noting that “physical therapy is equally, if not more, important than the surgery itself.” At Orthopedic ONE, our physicians and physical therapists work closely with each other and the patient to provide individualized attention and treatment, helping athletes return to sports safely.

“Our physical therapists are able to develop really close relationships with patients because they’re together for the full nine months, minimum,” Dr. Blackwell notes. “We have a really, really good physical therapy team. They care about patients, and they care about doing things the right way.” However, patients are also responsible for completing the assigned rehabilitation exercises independently, typically four to six days per week.

Along with the physical work, patients must battle the mental side of recovery. “It’s a traumatic injury,” Dr. Blackwell says. “Nine to 12 months is a lifetime for a young athlete.” Helping patients with that mental load is an essential part of care, and our team takes it very seriously, providing resources and support whenever possible.

Both physicians also stress that these strengthening and injury prevention programs shouldn’t stop once recovery ends. “Our job is to teach these athletes the tools and the skills they need to reduce the risk of injuries,” adds Dr. Blackwell, “and those exercises should be used for a lifetime.”

At Orthopedic ONE, care is built around collaboration and trust. We understand the physical and emotional toll an ACL injury can have, and our physicians and therapists will be there for you every step of the way. With the right team and a patient-first approach, recovery becomes a process patients don’t have to face alone.

Learn more about the ACL – and find a list of Orthopedic ONE physicians available to treat ACL injuries.