THE ACL ECONOMY: WHY A FREE WARM-UP LOSES TO A $26,000 SURGERY IN YOUTH SPORT

Female athletes tear the anterior cruciate ligament (ACL) at about 2.2 times the male rate per hour of play. Free twenty-minute neuromuscular warm-ups can prevent many of these injuries, yet surgery, costing tens of thousands of dollars, remains the usual response. This study asks why. Methods: A narrative synthesis of 28 published sources was combined with a club-level model of 100 female players over one season, using published efficacy, coach-survey and cost data. Results: Warm-ups cut ACL injuries by about 50%, and non-contact injuries in female athletes by about 67%. However, only 12.7% of surveyed coaches delivered them as prescribed. Full delivery would prevent 0.43 to 1.92 tears per 100 players per season and avoid US11,340toUS50,778 in surgical payments for about US$125; observed delivery prevents only 0.05 to 0.24. Clubs bear the costs, while insurers collect most of the savings.