As a through ball is passed behind the last defender, varsity girls soccer forward Shaili Betesh ’27 begins her run to meet the ball at the corner of the penalty box. As her cleats dig deeper into the grass with each step, the player marking her slowly falls further behind. The ball rolls only yards away from her as she thinks about the tied scoreless game and her first opportunity at a goal during the showcase. Just when the ball comes within reach, Betesh extends her left leg to lunge toward the ball. As her left foot slides forward, her right knee crashes into the ground. Betesh said she knew then that she tore her anterior cruciate ligament (ACL).
“[The fall] was no contact and I instantly heard it.” Betesh said. “It was just a classic textbook ACL tear.”
Betesh’s injury would be the seventh ACL tear within the school’s girls soccer program in the last four years, while the boys soccer program has had one ACL tear during that time. Female athletes are up to eight times more likely to tear their ACL than male athletes, according to Cedars-Sinai, nearly replicating the exact proportions in the school’s soccer programs.
Before the National Institutes of Health (NIH) Revitalization Act of 1993, there was no requirement to include women in medical studies, so research was done with the male body as the norm. For decades, women were systematically excluded from research, and medical observations were generalized between genders despite injury and disease patterns differing between the sexes. These inequalities in medicine would not end in 1993; in fact, 20 years after the act was passed, the NIH revisited the act and found that the number of minority and female patients enrolled in clinical trials was still considerably lower as well, according to the NIH. Less than 10% of current medical research is specifically focused on female health, according to the Women’s Health, Sports & Performance Institute.
Only recently has female-specific sports research been prioritized. In 2025, FIFA funded a study at Kingston University to investigate why female athletes are more predisposed to ACL tears by looking at female anatomy and physiology during the menstrual cycle. This study comes in response to the abundance of ACL tears in womens soccer.
Orthopedic Surgeon Babak Samimi said inefficiency of medical research on a wide range of people can affect how the research is able to be used.
“When we analyze research, we are making sure the groups and the control groups are as equal as possible,” Samimi said. “One of the main criticisms of medical research in the past is if the groups aren’t similar, then you have to take the results with a grain of salt. For example, the age, sex and other medical comorbidities are all a variety of factors that make each individual different and make them more susceptible or not.”
Samimi said anatomical differences and hormonal changes are two factors that affect the higher prevalence of female ACL tears.
“Because women have wider hips and more of an increased heel angle at the knee, when they land or when they are hit, there’s more of a valgus force on the knee, and it puts them at higher risk of injuring their ACL,” Samimi said. “So, that’s one hypothesis. The other is that the changes in the adolescent female with hormonal changes make their ligaments somewhat more susceptible.”
Samimi said research specifically on female ACL tears can help medical professionals make adjustments to lower risk potential.
“[Anatomical differences and hormonal changes] are the two areas of focus,” Samimi said. “One of the things we are trying to do to counteract that is to continue to do more research to see if there is a certain time in a women’s cycle where the ligaments are more susceptible and, if so, can we make modifications to their game schedule, when they could play, what they should do or how they can do it to mitigate any potential increased risk from that.”
One in four youths who suffer an ACL injury will suffer a second ACL injury in their athletic career, with the contralateral injury rate being higher than the ipsilateral graft re-tear injury rate, according to the American Journal of Sports Medicine. This can be due to a tendency to shift weight to the uninjured leg during recovery and developing landing mechanics that favor the uninjured leg. The school’s girls soccer team was led by three senior captains, who have a combined six ACL tears. All captains’ second injuries were contralateral injuries where they tore their ACL in the opposite knee.
Captain Sophia Waters ’26 said the shared injuries created an understanding and appreciation among the three.
“All of us being captains who have torn both of our ACLs made a good environment because we all know what each other have been through,” Waters said. “We are all so proud of each other for having accomplished what we have and being able to push through. It was really sad when it happened, but it has been a very supportive system.”
Waters said the two injuries were time-consuming and strenuous to recover from.
“Those two injuries were a big part of my soccer career,” Waters said. “The recovery, the rehab and just getting back to playing took a lot of time. Going through it twice was mentally challenging, and being able to pursue returning to soccer and keep pushing was definitely difficult.”
The psychological impact of ACL tears makes it difficult for an athlete to return to the field. Athletes often pivot to more calculated and guarded movements when playing. Captain Madi Holly ’26 said returning to the field after her first ACL tear was difficult.
“It was very much a mental block,” Holly said. “When I first got cleared to go back to practice, I was really excited, but once I actually got to do it, I was nervous to be back again.”
Holly said the recovery process was long and finds it upsetting how many other female players go through it.
“After my first tear, I didn’t start playing again until 13 months post-op, and then with this tear, I am still not playing after seven months,” Holly said. “Recovery is a very long process, so I think it’s definitely disheartening to know how prevalent it is, especially in girls sports.”
There is strong evidence for the efficacy of ACL injury prevention programs, demonstrated by a risk reduction of 52% in the female athletes and 85% in the male athletes, according to the Journal of Bone and Joint Surgery. Stretching activates muscle groups and specific training components for athletes participating in prevention programs are important.
Betesh said her team did not have a prevention program during club season.
“My club team wasn’t doing [preventative warmups],” said Betesh. “Some teams in our club do band work, but my team did not.”
From December to early March, girls soccer is in high school season. During this time, the athletes are only allowed to practice at the school, are training in the weight room two or three days a week and have priority access to sports medicine trainers. During this period, the team undergoes prevention exercises for ACL tears.
Sports Medicine Athletic Trainer Tiara Wells said when the high school season begins, the program ACL tears are less compared to during club season.
“[Outside of school season], the players are with their club teams, which is not something we necessarily have control over,” Wells said. “Control meaning minutes and how many games they are playing. So in that time frame of when we are actually in the high school season, we have had three ACL tears in the last five years. Have people in the program torn their ACL during the club season? Absolutely, and that number is a lot higher.”
Wells said sports medicine and sports performance have come together to revisit their prevention program and make it prioritize strength building.
“We have re-amped our warm-up program in the last couple of years,” Wells said. “We are using a lot more from the strength and conditioning room. Jeff, Hannah and myself all looked at what the warm-up used to be, and we edited it to really make sure we’re hitting the muscle groups we need to activate.”
Wells said the contact injuries are out of their control, but it is the non-contact injuries that they want to find the reasoning behind.
“It is a contact sport, so there are the injuries where the ACL is torn because of contact, and you can’t really do anything about that,” Wells said. “Then there are the non-contact ones, and those are the ones that we want to figure out why they happened.”
In January, the Women’s Health, Sports & Performance Institute funded a $50 million study to prevent injuries in female athletes. The Institute hopes to allow female athletes to benefit from research designed for them. Launches of studies like this and of FIFA’s ACL research, holds promise of more information in the future for female athletes.
Samimi said most of the understanding of why female athletes are more prone to ACL tears is theorized, and research can help lower the rate of tears.
“Right now it’s a more theory-based hypothesis as to what might be the reason [behind female ACL tears], but we don’t really have good science to understand it and understand how we can prevent it,” Samimi said. “Having the ability to study it and look at more specifics will allow us to be able to better manage and come up with a better preventative strategy in order to mitigate some of the rates we are seeing.”
