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Why women athletes face higher ACL injury risk than men, according to a sports physician

JuJu Watkins #12 of the USC Trojans after an injury against the Mississippi State Bulldogs in the first half during the second round of the NCAA Women's Basketball Tournament at Galen Center on March 24, 2025 in Los Angeles, California.
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JuJu Watkins #12 of the USC Trojans after an injury against the Mississippi State Bulldogs in the first half during the second round of the NCAA Women's Basketball Tournament at Galen Center on March 24, 2025 in Los Angeles, California.

Updated March 26, 2025 at 16:29 PM ET

University of Southern California's JuJu Watkins' record-breaking sophomore season came to a halt this week, as the rising basketball star sustained a severe knee injury during the NCAA women's tournament.

While pushing to the basket during the Trojans game against Mississippi State, Watkins tried to maneuver through two defenders. As she attempted the move, she crumpled to the ground, grabbed her right knee, and had to be carried off the court. USC later confirmed she tore her ACL and would miss the rest of the season.

"It's going to be hard to watch the rest of the tournament and think about the rest of the tournament without thinking about this injury," NBC Sports reporter Nicole Auerbach told NPR.

ACL injuries are particularly common in women's sports. Research shows female athletes are two to eight times more likely to tear their ACLs than male athletes.

Dr. Christina Allen, chief of Yale Sports Medicine and an ACL surgery specialist, spoke with NPR's Michel Martin about why female athletes tend to experience more ACL injuries and what recovery looks like. As a former college athlete and a team physician for U.S. men's and women's soccer, Allen offers these insights. The following has been lightly edited for length and clarity.

Why do women tend to suffer more ACL injuries than men?

Dr. Christina Allen: ACL injuries in women definitely are more prevalent. There are lots of studies in the literature about the higher incidence in women across different sports that are comparable, like basketball and soccer.

Of course, women don't usually play football, but that's an increasing sport. It's definitely a higher injury rate, and a lot of that can be attributed to differences in anatomy and training. As women grow up, anatomical differences include different quad-to-hamstring ratios — women tend to be more quad-dominant. Alignment differences versus men, as well as foot pronation, also play a role.

But there are other factors, too. As women grow up, there's historically been less emphasis on core strengthening, proprioception, and agility work. That's improving over time. Now, as women reach high school and college, strength and conditioning coaches are helping decrease the risk of injury.

What does recovery look like for an ACL injury like the one Watkins experienced?

Dr. Allen: It's a longer recovery. It was refreshing to hear Rebecca Lobo say that it was going to be a year for her to get back on the court. A lot of times in the past, we've thought, "Oh, it's an ACL injury — they'll be back in six months."

That belief largely comes from Adrian Peterson's amazing recovery years ago when he tore his ACL playing football. But now, there's a huge emphasis on meeting recovery milestones, both mental and physical. Athletes must regain at least 80% of their strength before they even start running. Then, they progress through a running and agility program, ensuring they meet all milestones before a slow return to play. That process can take up to a year.

What steps can athletes take to prevent injuries like this?

Dr. Allen: One of the most notable programs, since I was a soccer player, is the FIFA 11+ program. It emphasizes running, strength, plyometrics, balance drills, and stretching to help reduce the risk of injury. But rest is just as important. I think a lot of these injuries happen late in the season, when fatigue increases the risk.

This story was adapted for the web by Majd Al-Waheidi.

Copyright 2025 NPR

Michel Martin is the weekend host of All Things Considered, where she draws on her deep reporting and interviewing experience to dig in to the week's news. Outside the studio, she has also hosted "Michel Martin: Going There," an ambitious live event series in collaboration with Member Stations.
Mansee Khurana
[Copyright 2024 NPR]

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