ACL injuries in young athletes on the rise

SINGAPORE – Just three months before she was to make her international tournament debut at the 2024 Women’s U-19 World Floorball Championships, Kylie Chow had to limp out of the rink after going down with a knee injury during a floorball game.

“It was during a youth tournament for my club,” the now 17-year-old says. “I was jogging and made a turn, and I just felt my knee give way.”

She was told she had torn her anterior cruciate ligament (ACL), and so underwent reconstructive surgery and physiotherapy.

Fully healed a year later in March 2025, she once again tore the same ACL while warming up for what was supposed to be her first floorball match after recovery.

Kylie is not alone. Doctors The Straits Times spoke to say more young people are incurring risks of serious sports-related injuries such as ACL tears as they pursue sports at a younger age.

KK Women’s and Children’s Hospital (KKH) reported that the number of new ACL injury cases among youth under the age of 18 has doubled, from 81 in 2021 to 162 in 2025.

Associate Professor Mohammad Ashik, head and senior consultant at the Department of Orthopaedic Surgery and Singapore Sport and Exercise Medicine Centre at KKH, attributes the increase to more young people participating in sports and sport-related competitions.

Two other doctors that ST spoke to also say they have seen an increase in younger patients who suffer such injuries.

Dr Wang Lushun, an orthopaedic surgeon at Arete Orthopaedic Centre, says: “More young people are being exposed to competitive sports at an earlier age, partly due to the growth of structured sporting pathways and school admission schemes such as Direct School Admission (DSA).

“While these opportunities are beneficial for developing young athletes, they may also lead to higher training volumes and earlier specialisation in a single sport, which can increase the risk of certain sports-related injuries, including ACL tears.”

This observation is reflected in worldwide trends.

A 2017 study published by the American Academy of Pediatrics concluded that there was a 2.3 per cent increase annually in the number of ACL tears in patients aged six to 18 years old from 1994 to 2013.

Similarly, in Britain, new research from Coventry University linked poor childhood movement skills to a rising number of ACL injuries in girls, especially those playing football.

Doctors say ACL injuries can be caused by a variety of factors, such as increased training intensity among young athletes and insufficient rest, which can result in overuse injuries when the body is not given sufficient time to recover between repetitive activities.

“Competitive sport today can be quite demanding, particularly for young athletes who aspire to perform at a high level – many begin structured training from a young age as part of their development in the sport,” Dr Wang says.

“The physical demands of frequent training can be significant, especially for athletes who specialise in one sport and perform repetitive movements multiple times a week.”

Dr Wang also says that athletes most susceptible to suffering ACL injuries are those who play cutting sports – where they are frequently expected to perform rapid changes in direction – such as football, rugby or netball.

Anderson Serangoon Junior College student Saumya Rai tore her ACL in March 2025 when she tripped over a teammate’s foot while playing basketball during a training trip in Thailand.

“It sounded like paper tearing,” the 18-year-old recalls. “It didn’t hurt, but I remember my body going into shock. I wasn’t able to move my knee and had to be carried to the hospital after the game.”

After the game, Saumya was rushed to a hospital in Thailand, where she was put on crutches for the rest of the trip and told to visit a specialist if the pain and swelling persisted after a week.

Upon returning to Singapore, she found herself struggling to walk despite icing and applying pain-relieving cold sprays to her injured knee. She says: “I basically had to limp my way through the March holidays.”

A trip to an orthopaedic specialist revealed she had torn her ACL.

“It takes a toll on you mentally,” Saumya recalls when asked about her reaction to the news. “My whole TikTok algorithm was just other people talking about how long and difficult the recovery process was.”

Doctors estimate that the rehabilitation process after reconstructive surgery for an ACL injury takes nine to 12 months.

“I was worried that I would have to re-learn a sport that I already knew how to play,” Saumya adds.

Dr Ramesh Subramaniam, orthopaedic consultant surgeon at Avant Sports, Shoulder and Elbow Surgery Clinic, estimates that a third of patients will experience pain and instability in their injured knee in day-to-day life and require surgery after tearing an ACL.

Another third of patients will function normally in day-to-day life but experience instability playing sports, while the final third of patients will be able to return to pre-injury activity levels without much pain or instability.

Dr Ramesh says young athletes in particular should strongly consider reconstruction surgery after tearing an ACL, in addition to rehabilitative physiotherapy, even if they do not experience much pain or instability while playing sports.

He adds that younger athletes are at greater risk for re-rupturing their ACLs due to biological factors, such as more lax tissue and lifestyle-related factors such as increased engagement with high-risk sports: “Young people tend to engage with sports more fearlessly – it’s normal to feel invincible when you’re young.

“Without an ACL, the injured knee is intrinsically unstable, which increases the risk of other injuries to the joints or ligaments.

“The injured knee is also susceptible to long-term wear and tear without an ACL. For patients under 55, there are less definitive, available options such as knee replacements for treating this wear and tear.”

Prof Ashik estimates that for young athletes under 25, there is a 20 per cent to 25 per cent chance of sustaining a secondary ACL injury after suffering their first injury or tear.

He also adds that another procedure – lateral extra-articular tenodesis – can be added to ACL reconstruction surgeries to provide extra reinforcement and stability to the knee.

“Increasingly, this procedure is used for selected higher-risk patients, such as young athletes in high-impact pivoting sports or those with severe knee instability, who require more support,” he says.

Many young people, including all three young athletes ST spoke to, choose to undergo ACL reconstruction surgery so that they could continue representing their schools or teams in their sport.

After surgery, patients must be fitted with a knee brace and crutches for two to four weeks, and undergo nine months to a year of rehabilitation before they can play sports at a competitive level again.

Anglo-Chinese School (Barker Road) student Darryl Lim tore his ACL in May 2024 during a rugby game in May 2024, but underwent surgery only six months later.

The 16-year-old recalls experiencing some pain for the first few months after his injury, though he was able to move around unassisted after three weeks of using crutches.

He adds: “I waited until the school holidays because I wanted to focus on my studies. It did make me feel sad to have to wait for quite a while because I couldn’t train or do physical education.”

He was cleared to play rugby in August 2025 and has since re-joined his school team’s training.

Saumya fully recovered from her ACL tear in November 2025 and has begun training with her school’s basketball team. Despite this, she admits that she is now apprehensive over making sudden movements or turns on the court.

“Sometimes when I watch other basketballers train, I’ll just look at their knees and think about how easily one wrong move can cause them to be injured,” she says. “I just want to be injury-free this year.”

This rehabilitation process can be as mentally gruelling as the injury for some athletes.

After her first surgery in March 2024, Kylie attended three 1½-hour long sessions of physiotherapy a week.

Her sessions began with simple exercises that helped her walk again after her surgery, but gradually ramped up to running drills and strength-building exercises such as lunges and squats as she recovered.

Kylie says: “My life was mostly studying and rehabbing. It was like a part-time job after school.”

She is hoping to make a full recovery from her second ACL tear soon, and is hoping to be able to try to represent Singapore in major competitions in 2026. She still aims to play professionally in the future.

Prof Ashik says there are several steps young people can take to reduce their risk of ACL injuries, such as learning and practising correct landing and cutting techniques under qualified coaching.

They should also manage their training load carefully, and follow proven neuromuscular warm-up injury-prevention programmes such as FIFA 11+ for Kids, a structured warm-up programme designed to prevent injuries in football players aged seven to 12 that focuses on spatial awareness, body stability and proper falling techniques.