Sidelining the hoopster: ACL tears and other basketball injuries

Sports injuries in basketball players run the gamut from bruises and jammed fingers to sprains and strains. One of the more serious injuries is a tear of the anterior cruciate ligament (ACL), a tissue that provides stability to the knee joint.

Many basketball players at every level of play from youth leagues to the NBA have experienced this injury. Think Derrick Rose, Nerlens Noel, Jabari Parker, and Shaun Livingston — all of these players were sidelined by an ACL injury. The injury not only results in immediate time away from the court, but also may lead to a lifelong change in how the knee functions, which may restrict performance.

Several research studies support programs designed to reduce the risk of injuring the ACL. For example, conditioning programs should be structured to ensure development of normal joint range of motion and flexibility; balanced lower extremity and core muscle strength; and proper jumping/landing techniques. Ensuring time for rest to allow the body to recover and to avoid fatigue is also essential to optimal musculoskeletal function and injury prevention.

In the event that a basketball player tears the ACL, surgery is typically recommended for several reasons. A torn ACL causes the knee joint to be unstable, which gives the player a feeling that the knee is “giving out.” That instability disrupts normal knee function and results in excess force being transmitted to the cartilage and meniscus, which may lead to tearing and early arthritis. Through surgery a torn ACL is replaced with a new piece of tissue to restore stability to the knee joint. Restoring stability allows the return of normal function and reduces the risk of injury to the meniscus and cartilage.

Many factors must be discussed with an orthopedic surgeon to ensure that the appropriate surgery is performed in order to restore normal function to the knee joint. Some of these factors include timing of the surgery, type of tissue used to reconstruct the torn ACL, rehabilitation, and criteria for return to play.

In order to learn more about injuries in basketball players and, specifically, ACL tears, use the following resources and contact Dr. DeFranco at The Athletes Clinic with any questions:


  1. Preventing Basketball Injuries

  1. Sports Injury Forum Radio Show – ACL Injuries In Athletes

An interview and instruction from Dr. William Clancy, MD

Dr. Clancy is a world-renowned orthopedic surgeon and inventor of ACL reconstruction surgery. He was the orthopedic surgeon for the 1980 gold medal winning U.S Hockey Team (Miracle on Ice); U. S. Olympic Hockey and Nordic Ski Team Doctor; Former Chief of Orthopedic Surgery and Head Team Doctor for all Naval Academy Athletes. He was also team doctor for the University of Alabama, Georgia Tech University and Jacksonville State University.

  1. Anterior Cruciate Ligament Injuries–conditions/anterior-cruciate ligament-acl-injuries/




Young athletes are not smaller versions of adult athletes and should not be trained in the same manner.  There are specific differences in the body structure of a child that increase the risk of sports injuries in the younger population. Some primary differences include the following:

  1. Children have head to body proportions that create imbalance.
  2. Children are smaller in size and protective gear may not fit properly.
  3. Children have open growth plates. Damage to the growth plate can lead to early closure and abnormal growth of the bone. For example, injury to a growth plate around the knee joint may lead to a leg length discrepancy or a change in the alignment of the bone.
  4. Children lack mature motor skills, which usually do not develop until 10-12 years-old. During puberty, as children experience their growth spurt, a temporary decline in coordination and balance places them at greater risk for falling and sustaining an injury. Overall, they may not have the motor skills required for certain sports until after puberty.
  5. Children have softer bones and growing cartilage is more sensitive to the force across joints during activity. Both of these factors increase the risk of fracture and injury to the growth plate.

Some tendons attach to a special part of the growth plate in immature bone called the apophysis. In children the apophysis is separated from the main part of the bone. When a muscle contracts tension develops in the muscle-tendon unit and is transmitted to the apophysis. Repetitive pulling at the site of the apophysis creates inflammation, swelling, and pain. This condition is referred to as apophysitis and commonly develops in the elbow (Little League Elbow), the knee (Osgood-Schlatter Disease and Sinding-Larsen-Johansson Disease), and the heel bone, which is also referred to as the calcaneus (Sever disease). When the apophysis fuses to the main bone at the time of skeletal maturity (adulthood), these conditions no longer develop.

Peak height velocity (PHV) is the point in puberty when the tempo of growth is greatest. During this time, children and teenagers experience “growing pains” including conditions such as apophysitis. In general, PHV begins around age 9 in girls and age 11 in boys. As children grow they gain weight and are able to move faster. Their movements become associated with more force, which increases the risk of injury. Overall, the stages of development in each age group influence the capacity to adapt to the stress of athletic activity. Being aware of the differences in development between children, teenagers and adults is an important step in preventing sports injuries.