It’s the second round of the 2025 NCAA Women’s March Madness tournament, where the top 68 Division 1 basketball teams in the country compete to win a championship. 19-year-old Judea “JuJu” Watkins is having a fantastic second season at the University of Southern California, winning First-Team All-American accolades and living up to her five-star recruit status. The Trojans are the No. 1 seed in their region, projected to potentially win it all. Watkins has been an integral part of getting to this point — but as the AP Player of the Year drives to the basket, she’s fouled, and her right knee buckles. Watkins clutches her right knee, and is down for over a minute on the floor before she’s carried off by trainers. Shaken, the Trojans still manage to win the game, but they are later beaten by the University of Connecticut in the Elite Eight.

A day later, ESPN reports that Watkins has suffered a torn anterior cruciate ligament, or ACL. The ACL is one of four bands of connective tissue that connect the tibia (shin bone) to the femur (hip-to-knee bone). The ligament maintains knee stability while allowing joint rotation, making it vulnerable to tearing in sports where planting and cutting puts oppositional strain on the ankle and knee. ACL tears are associated with severe long-term health effects, including osteoarthritis and chronic inflammation, which raises the risk of heart attacks. Moreover, ACL reconstruction is costly, with the rehabilitation process taking up to two years: Watkins has been out for 15 months, but is expected to make her return in the upcoming 2026-7 season.

ACL tears are common among athletes who play basketball, soccer, and lacrosse, but they are significantly more prevalent in women’s sports. Female collegiate basketball and soccer players are three times more likely to tear their ACL than their male counterparts, and one in ten report sustaining a serious knee injury each year. In general, women who play sports have an ACL injury rate 1.7 times higher than that of men, with peak incidence occurring between the ages of 15 and 19. This disparity is due to several anatomical factors: femoral notches (through which the ACL runs) are smaller, and short thighs with wide hips create more knee strain. Furthermore, the release of hormones during the menstrual cycle, specifically during the follicular and ovulation phases, can make joints looser and more prone to injury.

There’s an interesting sociological angle, too. As youth sports become more specialized, children are more likely to pick one sport and train hard without an off-season, engendering what physical therapist Holly Silvers-Granelli refers to as a “lack of movement diversity.” When comparing sport-specialized and multisport female athletes, experts found that the specialized athletes had a significantly greater angle of abduction, meaning they were more susceptible to inward collapse and injuring their ACL.

Whether it’s losing a basketball championship and subsequent season after years of hard work and dedication, or having a ski trip with friends ruined, ACL tears are devastating injuries that pose a risk to anyone who exercises.

Fortunately, they can be effectively prevented by building functional muscle through regular strength exercises. Simply completing a 20-minute training routine (including strength, plyometrics, agility, and flexibility) two to three times a week can reduce the risk of injury by up to 75% for females playing high-risk sports. However, anyone who regularly exercises could benefit from taking time each week to strengthen their legs and core, warm up before a workout, and avoid exercise when overly fatigued.