Many of these individuals are not able to return to their pre-injury level of activity.22 Fifty-nine percent to 70% of these individuals would develop radiographically diagnosed knee osteoarthritis; 16%–19% would have symptomatic knee osteoarthritis over their lifetime, and 13%–15% would need total knee arthroplasty.17 Tremendous research and clinical efforts have been made in the last 2 decades to prevent ACL injuries and improve the rehabilitation after ACL reconstruction surgeries,23, 24 and 25 however ACL injury rates have not been reduced.