Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Comprehensive blend of general pediatric and sport medicine care with an individualized approach that enhances the health and knowledge of patients and their families



Proud physician:
USA Volleyball Mens/Womens National Teams
CS Fullerton Intercollegiate Athletics
Chapman University Dance Department
Orange Lutheran High School

Co-Author of Acclaimed Textbook

Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016


Let's Second the Importance of ACL Injury Prevention Programs

As if tearing an Anterior Cruciate Ligament (ACL) the first time isn't wonderful enough, the risk of a similar second injury within 24 months of returning to sport is frighteningly high, according to a recent study published in the American Journal of Sports Medicine.

In the population of 78 patients (mean age 17.1 years) who underwent surgical ACL reconstruction and made a return to cutting and twisting sports:

  • 29.5% of athletes suffered a second ACL injury with 24 months of returning to sport
  • Just over 2/3 of those second tears involved the opposite knee
  • Those opposite knee tears were more seen in female athletes

in my opinion, this high rate of second injury, especially in the opposite knee, adds even more evidence to the already strong suggestions that improper lower extremity mechanics play a significant role in ACL tears and that neuromuscular training programs are absolutely essential for prevention especially in female participants in high risk activities such as soccer, volleyball, basketball, gymnastics and lacrosse. 

Thankfully, there are several evidence-based programs readily found at no charge:

Best started as athletes reach early puberty (age 12-14), all of these programs feature stretching, strengthening, plyometric training and sport-specific agility exercise that all together take no more than 15 minutes and can easily be integrated into a regular warm-up routine that has been effectively taught to coaches both in-person and on-line.

No reasonable excuses exist for not utilizing these programs. The supporting science is solid, the programs aren't difficult to find or learn, and the time commitment for athletes and coaches is minimal.  

Parents and players need to demand these programs and reduce the risk of the ACL injury downward spiral that plagues far too many athletes.

Does your team incorporate neuromuscular training programs? If not, does this information make you more eager to encourage starting a knee injury reduction program? Would the presence of absence of the training program influence selection of a particular team?