ACL tears are one of the most common serious knee injuries, with roughly 75 out of every 100,000 people in the United States experiencing one each year. Between 2010 and 2020, more than 930,000 ACL tears were recorded in a large U.S. medical database. Your actual risk depends heavily on your age, sex, and which sports you play.
Overall Incidence in the U.S.
The annual rate of ACL tears has shifted over the past decade. In 2010, the incidence was about 90 tears per 100,000 people per year. By 2020, that number had dropped to roughly 53 per 100,000. The reasons for this decline aren’t entirely clear, but increased use of injury prevention programs in youth sports and changes in how injuries are coded in medical records likely play a role.
Even with that decline, ACL tears remain extremely common in absolute numbers. Hundreds of thousands of Americans deal with this injury every decade, and reconstruction surgery rates have actually increased over the same period, suggesting more people are opting for surgical repair when tears do occur.
Risk by Sport and Season
If you’re a high school athlete or the parent of one, sport selection is probably the biggest factor in ACL tear risk. A meta-analysis from Children’s Hospital of Philadelphia estimated the per-season risk of tearing an ACL for high school athletes across major sports:
- Soccer: 1.1% per season for females, 0.3% for males
- Basketball: 0.9% for females, 0.2% for males
- Football: 0.8% for males
- Lacrosse: 0.5% for females, 0.4% for males
- Field hockey: 0.4% for females
- Softball/baseball: 0.2% for females, 0.03% for males
- Volleyball: 0.1% for females
- Wrestling: 0.2% for males
Those percentages may look small for a single season, but they compound quickly over a four-year high school career. A female soccer player with a 1.1% risk per season faces roughly a 4.3% chance of tearing her ACL at some point during high school. For a male football player at 0.8% per season, the four-year risk is around 3.2%. Sports that involve cutting, pivoting, and sudden deceleration carry the highest risk, which is why soccer, basketball, and football consistently top the list.
Why Females Are at Higher Risk
Across nearly every sport, females tear their ACLs at three to six times the rate of males. The overall per-season risk for female high school athletes is 0.7%, compared to 0.4% for males. That gap has been documented for decades and holds true across age groups and competition levels.
Several biological factors contribute. Women tend to have a narrower notch in the femur where the ACL sits, which leaves less room for the ligament and may make it more vulnerable to stress. The ACL itself tends to be smaller in women. Hormonal fluctuations, particularly in estrogen levels during the menstrual cycle, appear to affect ligament stiffness, though the exact mechanism is still debated. Neuromuscular differences also play a role: women tend to land from jumps with straighter knees and more inward knee collapse, both of which put extra strain on the ACL.
Training background matters too. Athletes who develop strong hamstrings relative to their quadriceps, and who learn proper landing and cutting mechanics, can reduce some of the neuromuscular risk. Prevention programs targeting these movement patterns have shown real results in reducing ACL injury rates in female athletes.
Rising Rates in Young Athletes
One trend that stands out is the sharp increase in ACL injuries among children and adolescents over the past two decades. Pediatric ACL reconstructions, particularly in athletes younger than 15, have risen significantly. The main driver is increased sports participation at younger ages, with more kids playing year-round on competitive travel teams rather than rotating between seasonal sports.
ACL tears in young athletes are especially concerning because the growth plates in the knee are still open, which complicates both surgical planning and recovery. Young athletes who tear their ACL also face a higher risk of re-injury compared to adults, particularly if they return to pivoting sports.
Surgery vs. Rehabilitation
Not everyone who tears an ACL needs surgery. In a randomized trial comparing early surgical reconstruction to a rehabilitation-first approach, half of the patients assigned to physical therapy alone never needed surgery during the follow-up period. They recovered enough knee stability and function through structured rehab to return to their activities without reconstruction.
The other half eventually opted for surgery, typically because their knee felt unstable during sports or daily activities. The decision often depends on your activity level, which sports you want to return to, and whether the knee gives way during pivoting movements. Young, active athletes who want to return to cutting and jumping sports usually lean toward reconstruction, while older or less active individuals may do well with rehab alone.
Long-Term Impact on Knee Health
Perhaps the most sobering statistic about ACL tears isn’t about the injury itself but what comes after. About 38% of people who undergo ACL reconstruction develop osteoarthritis in the injured knee within roughly 15 years. For those who skip surgery and manage the injury with rehabilitation alone, the rate is even slightly higher at around 40%.
The fact that arthritis rates are similar whether you have surgery or not tells an important story: the initial trauma to the joint, not just the torn ligament, drives long-term cartilage damage. Additional injuries that often accompany ACL tears, like meniscus tears and bone bruises, accelerate the process. This means that preventing the ACL tear in the first place, through neuromuscular training programs and smart sport participation decisions, has benefits that extend decades beyond the playing field.