Few acronyms strike fear in the hearts of athletes like “ACL.” An injury to this crucial ligament in the knee joint can be devastating, causing athletic setbacks of a year or more. JuJu Watkins, Megan Rapinoe, Alex Morgan and Lindsey Vonn have all suffered ACL tears in their careers. But while ACL injuries that happen to major athletes make headlines, everyday women struggle with them too — and like professional athletes, these injuries can be life-altering.
Mica Riley knows this terrain firsthand. The physical therapist and founder of the ACL Motive has torn her ACL three times — in 2009, 2013 and 2023, all while playing soccer. “The first two were noncontact injuries where I was just running and turned and it just popped,” she tells Yahoo Life. “The last injury was a contact injury. I went in for a 50/50 ball, planted my foot and got kicked in the back of the leg. I heard a loud click, tried to take a step and my knee instantly gave out.”
Each injury was frustrating, but Riley says the first and last were the hardest to grapple with. “In 2009, I didn’t have a lot of physical pain, but the mental toll was massive,” she says. “I lost my identity, my social circle and everything that grounded me. I was a young athlete who suddenly didn’t belong in the same spaces anymore — and I had no tools to process that loss.”
Riley also dealt with depression after her ACL injuries. “The emotional toll of an ACL injury is wildly underestimated,” she says. “People think that once you’re walking, you’re fine — but the truth is, you’re grieving.” Riley also says she struggled to do basic tasks for the first three months after her last injury, including getting dressed, bathing, cooking and cleaning.
“One of the most vivid moments for me came around five days post-op,” she says. “My husband had to help me bathe. I sat in the tub, completely still while he helped, and I just sobbed for 45 minutes straight. I wasn’t crying from pain. I was grieving the loss of my independence. It was one of the most vulnerable moments of my life.”
Riley says that injury causes you to lose your routine, your ability to move and your sense of control. “You go through waves of anger, frustration, and a lot of tears. You’re incredibly uncomfortable, and you just have to sit with it. For most people, myself included, that’s really difficult.”
Even though she’s a physical therapist who helps people with ACL injuries, Riley says she struggled with fear, anxiety and grief during her recovery. “Just knowing what to do doesn’t make it emotionally easy,” she says.
Kelsey Kryger, Sam Marks and Mica Riley have all suffered ACL injuries and say having a support system is a crucial part of recovery. (Photos courtesy of Kelsey Kryger, Sam Marks and Mica Riley)
Kelsey Kryger, social media manager for the ACL Club, tells Yahoo Life that she felt “depressed and hopeless” after injuring her ACL in 2020. “During my ACL recovery process, I really struggled with the mental side of recovery,” she tells Yahoo Life. As someone who relies on exercise to keep herself “sane and mentally in check,” Kryger says she felt defeated going from being in the best shape of her life to struggling with even just getting a full revolution while peddling a bike.
“It was a very isolating and lonely process because I felt like no one close to me fully understood what I was going through and how much the injury was affecting my mental state as well,” Kryger says.
Sam Marks, a dietitian and wellness coach, echoes that sentiment, telling Yahoo Life that, even after taking a higher dose of antidepressants, she experienced suicidal thoughts after tearing her ACL in 2023 while skiing. “It is easily the hardest thing I’ve ever gone through, and I still experience anxiety about anything like that happening to me again,” she says. “Unfortunately, three different [mental health] therapists over about 18 months didn’t help me much through the experience. It feels as if it’s something you just have to white-knuckle through.”
Why are ACL injuries more common in women than men?
Women have an “alarmingly higher rate” of ACL injuries — up to an eight times greater risk than men — and doctors say there are a few reasons for that. “There are hormonal factors. Women have more estrogen, which makes ligaments have more laxity and can lead to increased risk of tearing,” Dr. Jason Womack, chief of the Division of Sports Medicine at Rutgers University’s medical school, tells Yahoo Life.
Women’s knees are also typically in more of what’s called a valgus position than men due to having a wider pelvis, which causes the knees to point inward, usually when they jump and land, Dr. Mark Slabaugh, an orthopedic sports medicine surgeon at Baltimore’s Mercy Medical Center, tells Yahoo Life. “There can be an imbalance of the strength of the knee compared to the hip, putting the ACL at risk when participating in sports,” he says.
But it’s also possible for women to tear their ACL without trying to achieve athletic feats. Marks was on the ski slope when she tore her ACL, but she says she simply crossed one leg over the other while standing when the injury occurred.
The recovery period is really long
ACL tear are treated through reconstructive surgery, Dr. Alan Beyer, an orthopedic sports medicine surgeon with Hoag Orthopedic Institute, tells Yahoo Life. “You can’t just sew together the ends of the torn ligament and hope it will heal,” he says. Instead, doctors will take a graft from another part of the patient’s body or a donor to reconstruct the area. “It’s usually a six- to nine-month rehabilitation process until the new ligament grows and develops a blood supply,” Beyer says.
While patients will slowly regain mobility, Womack says there is usually “a period of time of immobilization of the knee after surgery,” where it’s difficult to follow a normal routine. “Physical therapy starts quickly to regain motion and muscle strength,” he says.
Recovery from an ACL injury is “a process,” Dr. Bert Mandelbaum, co-director of the Regenerative Orthobiologic Center at Cedars-Sinai Orthopaedics in Los Angeles, tells Yahoo Life. “You’re not only going through rehab, but you’re getting used to a new lifestyle of correcting and strengthening deficiencies that may have been there before the injury.”
How to get through the ACL recovery process
Because the ACL recovery process is arduous, doctors say it’s crucial to let the body heal during this time. “We’ve started to be more conservative and to push out the time frame for recovery,” Slabaugh says. “If you go back too soon, before that graft is completely mature, it’s at risk for re-tearing. It’s not fully matured until about a year after surgery.”
Because of this, Mandelbaum says that there’s “a little depression” built into the recovery process for many people. “It’s something that we need to deal with as well,” he says.
Kryger says she found support online after discovering the ACL Club. “It was really helpful to connect with others who were going through the same thing and firsthand understood the daily struggles of ACL injuries,” she says. “Learning more about the body and its mechanics was empowering as well, and I really became interested in strength training through the injury.”
Riley built a team of people around her that helped her both physically and emotionally. That included hiring a mental health therapist, which she says was one of the best decisions she’s made. Seeing a therapist regularly “gave me the resilience to ride that emotional roller coaster. It helped me face the frustration, sadness and pressure without letting it break me,” Riley says.
Slabaugh stresses the importance of having patience with the recovery process. “You have to build up your endurance, strength and psychological readiness,” he says. “You can’t rush it.”
While Riley says her latest ACL recovery was difficult, she’s now back to normal. “I feel strong, grounded and proud of how far I’ve come,” she says. “I’m not just physically back; I’m more resilient than I’ve ever been.”