Helping Kids Safely Return to Sports After an ACL Injury: What Parents Should Know

Anterior cruciate ligament (ACL) injuries are becoming more common in kids and teens, especially due to the significant increase in year-round play. These injuries can be season ending, but with the right care — including surgery and a strong recovery plan — young athletes can get back to doing what they love safely.

What is an ACL injury?

The ACL is one of the main ligaments in the knee. It helps keep the knee stable during movement, especially during sports that involve cutting or pivoting — like soccer, basketball and football.

ACL tears are more common in young athletes because their muscles and movement patterns aren’t always strong or balanced enough to protect the knee during fast, twisting motions. Playing the same sport all year without breaks also puts extra stress on the knee and doesn't allow time to rest or cross-train. Girls are at higher risk than boys, which is thought to be a result of differences in body structure and hormones.

Why surgery is often the best option

In the past, doctors sometimes waited to do ACL surgery on kids until they were skeletally mature. Today, we know that waiting could lead to more injuries, especially if the knee is unstable.

“We no longer recommend delaying ACL surgery until skeletal maturity for pediatric patients,” said Neel Kushare, MD, pediatric orthopedic surgeon and sports specialist at Texas Children’s. “Waiting with underlying joint instability increases the likelihood of secondary cartilage injuries.”

At Texas Children’s, we perform ACL surgery in a way that safeguards growth plates and matches each child’s stage of growth. 

Preventing a second injury

Once an ACL is injured, young athletes are at risk of injuring the same knee again. To help prevent this, our surgeons may do additional procedures at the same time as the ACL repair to decrease the chances of reinjury:

LET (lateral extra-articular tenodesis) or ALL (anterolateral ligament) reconstruction: This procedure helps make the knee more stable by taking pressure off the parts of the knee that twist, adding extra support to prevent it from giving out. These procedures are especially helpful for active adolescent and young adult athletes who are involved in pivoting sports and are more likely to reinjure their knees.

A team that understands kids

Our entire team — from physical therapists to athletic trainers to counselors — is trained to work with young patients. We also work closely with schools and coaches to support recovery both in and out of the hospital.

Our goal is not only healing the knee but also helping your child return to sports safely and with confidence.

How we know your child is ready to return to sports

Most kids return to sports about 9 months after ACL surgery, but only if they’re truly ready. At Texas Children’s, our experts use motion analysis to track how your child is moving as they recover. Using high-speed cameras and force plates, we test key areas such as:

•  Lower-body strength and power
• Jumping and landing control
• Running technique and coordination
• Ability to appropriately load the surgical knee

“We use advanced motion analysis to understand how patients move during high-demand activities that simulate the challenges of returning to sport,” said Dr. Kushare.

The mental side of recovery

Even if your child is physically strong, they might not feel ready mentally.

“Even when a patient looks good on a strength test, they may not be psychologically ready to return,” Dr. Kushare said. “If an athlete isn’t confident, they’re more likely to favor one leg and risk a reinjury.”

That’s why we include sports psychologists and counselors as needed in the recovery plan. Confidence and mindset are just as important as strength and flexibility.

Start strong, stay safe

Getting the right treatment early gives your child the best chance for a full, safe recovery. At Texas Children’s, we focus on healing the whole athlete: body and mind.

If your child has an ACL injury or is struggling after one, we’re here to help.

Learn more about ACL treatment and recovery at Texas Children’s Orthopedics and Sports Medicine. We’re ready to support your family every step of the way.