Anterior cruciate ligament (ACL) tears are a significant concern for young athletes, especially teenage girls involved in high-impact sports such as soccer, basketball, and volleyball. Research shows that female athletes are up to eight times more likely than their male counterparts to experience an ACL tear, which often leads to surgery and extended recovery periods.
Michael Banffy, MD, chief of Sports Medicine at Cedars-Sinai Orthopaedics, explained the function of the ACL: “The ACL—or anterior cruciate ligament—is one of four main ligaments in the knee. It crosses over inside the joint and helps control both the rotation and forward movement of the tibia (shinbone) relative to the femur (thighbone). It helps stabilize the knee and protects structures like the meniscus and cartilage during pivoting or cutting movements.”
Dr. Banffy outlined several reasons why young female athletes face higher risks: “It’s multifactorial. Anatomically, females tend to have a more ‘knock-kneed’ alignment—called valgus—which can put more stress on the ACL when landing or changing direction. They also typically have less muscle mass around the knee compared with males, which limits the protective effect of the surrounding musculature. And we believe hormones, such as estrogen and progesterone, affect ligament laxity and may play a role, though we’re still learning exactly how.”
He noted that adolescent females are particularly vulnerable during puberty due to hormonal fluctuations. Recent studies from Cedars-Sinai suggest that increased estrogen levels during certain menstrual cycle phases may heighten ACL injury risk.
Regarding which sports present greater dangers, Dr. Banffy said: “Sports that involve jumping, cutting and pivoting—like soccer, basketball and volleyball—tend to have the highest rates of ACL injuries. These movements can put sudden, intense strain on the ligament, especially if athletes haven’t developed proper landing techniques.”
Signs of an ACL tear can be immediate or subtle. According to Dr. Banffy: “Often, it’s obvious. Many athletes report hearing a ‘pop’ and experience immediate swelling or instability. But not every tear is dramatic—some are more subtle, especially in non-contact injuries. A common symptom is a feeling of the knee ‘giving way,’ even if there isn’t much swelling or bruising.”
Diagnosis involves clinical examination followed by imaging such as MRI scans. Dr. Banffy described treatment protocols: “For young, active individuals, surgery is strongly recommended to reconstruct the torn ligament—typically using a tendon graft from the same leg. While the patient may feel normal after a few weeks, full recovery and return to sport often takes nine to 12 months to allow the graft to mature.”
Prevention strategies are available for at-risk athletes: “Absolutely. ACL prevention programs—which include strength training, neuromuscular control drills and landing technique instruction—are critical. These programs are often built into team warmups and can significantly reduce injury rates when done consistently. For example, simple bodyweight exercises like squats and hamstring-strengthening movements help stabilize the knee, while jump training teaches athletes how to land safely and with control,” said Dr. Banffy.
He advised patience for those recovering from surgery: “Be patient. The ligament may feel fine after a few months, but the biology takes time. Pushing too soon can risk reinjury, which is heartbreaking for athletes. We use force plate testing to measure balance and strength between legs—once the injured leg is at least 85% as strong as the uninjured one, we can gradually reintroduce sport-specific training.”
Dr. Banffy also cautioned about increased risks following an initial injury: “If you’ve already had one ACL injury, your risk of injuring the opposite knee is four times higher. That’s why prevention training is so important—not just before injury, but especially afterward. And while reinjury can be discouraging, it’s not the end. Revision surgeries are possible, and many athletes successfully return to sport with the right treatment and rehab.”
Cedars-Sinai Medical Center has been serving Los Angeles since its founding in 1902 under current president Thomas M. Priselac; it operates as both a pediatric hospital and a training facility for medical professionals while admitting over 50,000 patients annually according to its most recent report.
Further information about athlete safety is available on the Cedars-Sinai Blog.
