| In early March, I heard the pop no one wants to hear. An MRI confirmed my fears – I tore my anterior cruciate ligament in a skiing accident and joined the club of 100,00 to 200,000 Americans a year who experience an ACL tear. In my research about the surgery and recovery process, I learned that women are up to eight times more likely to experience a tear compared with men. It's partially explained by women playing more competitive sports year-round, especially as student athletes. Denver-based orthopedic surgeon Catherine Logan says there are also two other factors: female anatomy and physical behavior, like a lack of hamstring strength or landing from a jump on a hyperextended leg. Behaviors can change with conditioning and practice. But you can't change anatomy. The ACL is a knee ligament that allows you to move side-to-side and pivot — something crucial in high impact sports. The MCL, or medial collateral ligament, helps your knee move back-and-forth. Both connect your thigh bone to your shinbone and stabilize your knee. Women have wider-set hips so the femur bone connects to the knee at an angle, making women more knock-kneed and putting stress on the ACL, Logan says. Plus, the pocket that holds the ACL is smaller in women, leaving less space to protect the ligament if you twist in the wrong way. Hormones play a role too. Women have higher levels of estrogen – a hormone that contributes to bone health. Estrogen levels fluctuate depending on their period cycle, meaning higher estrogen levels could leave you more susceptible to an injury by creating an environment that makes the ACL looser, according to Logan, who is also the team physician for USA Lacrosse. Logan says female patients ask her, "How are we supposed to control any of this?" The answer comes down to them taking recovery after an injury seriously. Women are generally less likely to return to their sport after an ACL injury, but physical and psychological interventions can improve the rate of return, according to a recent study in the Journal of Orthopedic Reports. Confidence can increase through working hard at physical therapy, which can help you come back stronger. "There's a difference between returning to play and returning to performance," Logan says. "The goal should always be to get back to your level of performance." Women athletes including Lindsey Vonn and Megan Rapinoe have torn their ACLs multiple times and still returned to compete at the Olympic level. Who knows? Maybe I'll be skiing at the Milan Winter Olympics in 2026 after a long physical therapy. — Jessica Nix | 
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