ACL injury doesn't have to end your child's sports dream. Here's 5 tips for full recovery

If you’re a baseball fan, you’ve likely heard of Rhys Hoskins.

Hoskins pounded 148 home runs in 667 games for the Philadelphia Phillies over six seasons. But he didn’t play a game last year after he had surgery in March to repair a torn anterior cruciate ligament (ACL) in his left knee.

The Brewers still scooped him up on a two-year, $34 million deal. He’ll likely be Milwaukee’s starting first baseman by opening day, when he expects to have little to no limitations from the injury.

If you’re a football fan, you’ve almost definitely heard of Michael Penix Jr.

Penix was a rising star as Indiana's quarterback over four seasons. But he missed large parts of them with injuries, including time after surgeries for not one, but two torn ACLs in his right knee.

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Though Penix threw 67 touchdowns in two seasons after transferring to Washington, taking the Huskies to the brink of a national title in January, NFL teams were scrutinizing his medical records. They were watching him extra closely as he worked out this weekend at the combine. Do they take a chance drafting him?

"I’m not even at my peak yet," he told USA TODAY Sports last month. “I just need the opportunity."

If your young athlete is recovering from an ACL tear, Penix, as well as Hoskins, should give you optimism. They should also give you pause.

How your child goes about recovering from a torn ACL isn’t the same as how a pro does it.

“We tell Mom and Dad that your teenager is not an adult and your recovery, while it’s the same name on the surgery you’re having, is a really different process that you’re gonna undergo with your recovery,” said Dr. James E. Voos, chairman of orthopedics at University Hospitals in Cleveland and head team physician for the Browns.

One of Voos’ goals in a new study, which was presented at the American Academy of Orthopaedic Surgeons annual meeting, is to highlight adolescents' specific risk factors for ACL injuries.

As a parent, you not only need to understand your son or daughter who is active in sports can tear an ACL; you need to know he or she can do it again if they don’t take proper care in recovering from it.

USA TODAY Sports spoke with Drs. Voos and Bhargavi Maheshwer, the paper’s lead author and a third-year orthopedic surgery resident at University Hospitals, about what adolescents and their parents can do to protect against both scenarios.

1. Start your child on a healthy sports plan to safeguard against injuries

“Last year, I did more 12-year-old ACLs than I’ve ever done in my over-10-year career,” Voos says. “Kids are training year round, sports specializing, they’re working out like adults while they’re still kids and I think that’s increasing the risk.”

For early prevention, ask yourself these questions:

• Does your child want to play this sport? Never force your kid to play a sport. You want them to put forth their full effort and attention.

• Has your child prepared for that sport? Make sure your son or daughter is in running shape and has had a chance to acclimate to the movements of a sport. This can be as simple as kicking a ball with them in the backyard or shooting baskets. “You don’t just want to decide to play soccer and jump out of the minivan and run out and play,” Voos says.

• Have you checked equipment and environment? Find footwear that fits and suits the grass or turf on which your child will be playing. Find out if the team’s field is well kept up and free of areas where kids might trip.

• Is the league committed to safety? Ensure coaches have taken safety courses before they coach your kid. Then watch how a coach runs practice to make sure safety is a priority.

2. Recovery is a 'team sport.' If your child tears an ACL, make sure everyone understands the risks

Voos and his associates have seen a larger prevalence of ACL reinjuries among the high school-aged patient population. Their study, entitled, “Predictors of Anterior Cruciate Ligament Reinjury and Return to Sport in Adolescent Athletes,” observed 431 patients within an age range of 13 to 18 who underwent ACL reconstruction.

About 20% of the athletes involved in the study experienced a secondary ACL injury. The orthopedists found the younger the patient, the higher the rate of recurrence.

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ACL injuries can have devastating emotional effect on kids as they remain inactive. They need to know that you, and everyone around them, is with them every step of their recovery. Remember, it's them, not you, who is injured.

“Counseling and managing expectations sometimes can be disproportionate between the parents and the kids and you’re kind of almost counseling the parents more so,” Maheshwer says.

As a parent, you play a critical role in the recovery. Be right beside your son or daughter form the beginning. Carefully choose your orthopedist like you’d pick a coach for your kid’s travel team. Look for a doctor who sees patients similar to your child in age and activity level.

Such a surgeon will be most aware of your kid’s risk factors and perform the best procedure and rehab regime for the situation. Then think of the recovery, Voos says, as a team sport:

“It’s the parents. It’s the athlete. It’s their coach. It’s the physical therapist. It’s the athletic director at their school. It’s their club team coach," he says. "Really making sure everybody’s on the same page and committed to that athlete’s safety, so there’s as much logistical planning for these as there is surgical planning."

3. It's hard to wait, but don't hurry ACL recovery

Penix, who was 18 when he first tore his ACL in 2018, felt the pull to get back because he was still competing to become an established college quarterback. Hoskins, who was 29 when his injury occurred last March, was anxious to re-establish himself as the Phillies were eliminated in last year’s NLCS and he hadn’t quite made it back.

“It was intense, and emotional, just the unknown of what was to come with my future,” Hoskins told USA TODAY Sports.

Now think of your 16-year old. That’s the average age of the athletes in the study when they experienced their initial ACL tears.

They’re trying to make varsity for the first time or perhaps they’re already in the prime of their high school careers and looking to get noticed by college coaches. As a parent, you know how real those pressures are. This injury can wipe out an entire school year of sports.

The University Hospitals orthopedists recommend waiting at least nine months to return to sports following an ACL injury. Their study found, though, there is a 17% reduction in risk of a recurrent injury every month you wait to return.

“Many of these athletes still had open growth plates, meaning their body is still growing,” Voos says. “Waiting to reduce the risk comes into play because that athlete is still getting taller and stronger and learning how to move their body.”

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4. With a torn ACL, both knees are at risk of injury

The doctors followed this group of adolescents up to five years from surgery. Over that period, there was a 9% risk of re-tearing the same knee but an 11% risk of tearing the other knee.

If you return to sports too quickly, Voos says, the surgical knee may not have fully recovered and so you’re relying on the other leg too much.

J-Sun Harris, Penix's former teammate at Indiana, tore his ACL three times in college. A year after his initial tear of his right ACL, his left one gave out on a jab step in practice.

“I’ve seen different ways you can tear it. It’s not the cruel leg-hit-from-the-side deal. Half the time, it’s not that,” Harris told The Indianapolis Star in 2021. “It’s the subtle stuff.”

Among the adolescent population, the risk of having a recurrent ACL injury lingers. It went from 5% to 9% over the five-year period Voss and his associates studied their group.

These patients, like Penix, have so much of their athletic lives ahead of them. You can still embrace it after an ACL injury.

5. Give your kids an offseason. They can recover 100% from an ACL tear — if they rest.

Depending on what study you read, 60-98% of patients returning from an ACL tear can return to their same level or greater of athletic performance.

That high-90 percentile, Voos says, is stamped into place when you’ve given yourself the appropriate time to heal. Your body needs to regain its range of motion, symmetry, strength and coordination.

Penix, who tore his ACL a second time 25 months after the first tear, waited more than nine months to play in another collegiate game after each injury. Hoskins waited almost a year in between the game he was injured last March and his first spring training game of 2024.

Rest is a strategy you can apply whether you’re recovering from an injury or just trying to prevent one.

"You finish soccer, you made it to the playoffs and you do basketball tryouts," Voos says. "We see those injuries in the transition periods all the time. So I tell the parents, 'Get out your calendar and map out the breaks.’ Give your kids an offseason. Every pro sport has an offseason. Why would you not give your child an offseason?

"The high schools we take care of in our system, we’ve really preached that to our athletic directors: Your transition athletes that are switching sports, don’t make ’em go try out the next day. Give ’em a break."

Steve Borelli, aka Coach Steve, has been an editor and writer with USA TODAY since 1999. He spent 10 years coaching his two sons’ baseball and basketball teams. He and his wife, Colleen, are now sports parents for a high schooler and middle schooler. His column is posted weekly. For his past columns, click here.

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