The first time Dylan Raath's knee gave way, he heard an ominous crack. He was running with a football in his hands, got tackled from behind, and twisted his left knee so hard it ruptured his anterior cruciate ligament. Mr Raath remembers the sound of it tearing well.
It was a painful introduction to an injury on the rise among young people in Australia, particularly those who play football, rugby, soccer and netball - sports that involve jumping, landing and stepping side to side.
Mr Raath went on to suffer another two ACL injuries while he was playing Australian rules football as a teenager. All three required surgery, causing him to lose four-and-a-half years of playing the sport he loves.
While Mr Raath, 24, may have been unlucky, experts say about half of all ACL injuries could be prevented if young people received balance and agility training tailored to their sports. The training teaches them to land and move in a way that avoids the dangerous twists and turns that often cause ACL injuries.
Leading knee surgeon Chris Vertullo said that research showed Australia had the highest rate of ACL injuries in the world, requiring more than 10,000 surgical knee reconstructions a year. He said the major burden of these was among 15-25 year-olds, and was rising 5 to 6 per cent each year. Sport injuries are so common, he said, they now lead to more hospital admissions than road injuries.
With research showing specific training exercises have reduced ACL injuries in elite athletes, Associate Professor Vertullo of Bond and Griffith universities, is pushing for community sporting groups to get the same training.
He and others are hoping a meeting with the Australian Sports Commission this month will see the training delivered to community teams which are usually run by volunteers.
Head of the Musculoskeletal Research Program at Griffith University in Queensland Professor David Lloyd said the Australian Football League had supported research to develop a range of injury prevention strategies that could be used more broadly.
He said one study of 1600 community level Australian rules football players showed the training - done three times a week for 20 minutes - could reduce the relative risk of ACL and other lower limb joint injuries by 50 per cent.
Associate Professor Vertullo said preventative training was a cost-effective intervention because people who suffer an ACL injury are at greater risk of developing premature osteoarthritis in their knees, which can cause severe disability later in life.
He said their research suggested an ACL injury prevention program targeting all 12‐17 year olds and high risk 17-25 year olds would cut future public health costs by $120 million over four years.
"This doesn't include the total society costs of decreased sports participation, and lost work," Associate Professor Vertullo said at the Royal Australasian College of Surgeons annual scientific congress.
Dr Ruben Branson, a sports medicine doctor who has previously worked for Collingwood Football Club, said he saw young people with devastating ACL injuries every week that kept them out of sport for nine months to a year. He said they were more common in females possibly because of anatomical and physiological differences including hormonal changes during different times of the menstrual cycle.
Dr Branson, who works at Sportsmed Biologic in Box Hill, said up to 65 per cent of people who suffer an ACL injury will get osteoarthritis in their knee within 10 years. He said his clinic was running a trial to see if a drug could help prevent osteoarthritis of the knee in people who have had an ACL injury.
Mr Raath said after the turmoil of three ACL injuries, including one that was "heartbreaking", he hoped the prevention programs would receive funding.
"It's an incredibly slow process to recover. It takes about six months to be able to put pressure on your knee and get to a slow jog if you're lucky," he said. "A prevention program is a very good idea".
Julia Medew travelled to the RACS congress as a guest of the college
