Dr. Robin West Responds to "Why Are So Many Teen Girls Still Tearing Their A.C.L.s"

March 12th, 2026

Two weeks ago, The New York Times Magazine published a story that went viral. It posed a question that is at the core of Caddix's mission: Why Are So Many Teen Girls Still Tearing Their A.C.L.s?

This week, one of our medical advisors, Dr. Robin West, responded to the story.
 
Dr. West is a board-certified orthopedic and sports medicine surgeon. She's the current lead team physician for the Washington Nationals and was the first woman in history to serve as head team physician for both an NFL and MLB franchise simultaneously. 
 
 Read her perspective below:

"The recent New York Times Magazine article brings important attention to a topic that many of us in sports medicine see every day in clinic and on the field: the disproportionate rate of ACL injuries in female athletes. Over the past several decades, participation in girls’ and women’s sports has grown dramatically, which is an extraordinary success story. At the same time, we have seen a parallel rise in ACL injuries, particularly in sports that involve cutting, pivoting, and rapid deceleration. Female athletes experience ACL injuries at significantly higher rates than their male counterparts, and understanding why has become one of the most important questions in injury prevention.

 

ACL injuries are multifactorial. There is no single explanation. Anatomical, biomechanical, hormonal and neuromuscular factors all contribute. Differences in hip and knee mechanics, landing patterns, and neuromuscular control can influence how forces are absorbed during high-risk movements such as cutting, planting, and landing from a jump. These are the moments when the knee experiences the highest rotational and shear forces.

 

I also want to acknowledge the tremendous work done by Holly Silvers-Granelli, whose research has been foundational in helping to identify and address modifiable risk factors for ACL injury. Her injury prevention work has provided practical, evidence-based strategies that coaches, teams, and athletes can implement to reduce risk. Programs like the PEP program demonstrate that structured neuromuscular training can significantly reduce ACL injury rates. In my view, all athletes should be familiar with and follow these types of prevention strategies.

 

However, it is equally important to recognize that injury risk is not determined by the athlete alone. External factors play a meaningful role and are often overlooked in the broader conversation. Footwear, playing surface, and weather conditions all influence traction and rotational resistance at the shoe-surface interface. Stud configuration, stud flexibility, and the ability of a cleat to allow controlled rotational release can affect how forces travel through the foot, ankle, and knee during pivoting movements. Surfaces such as natural grass and artificial turf behave differently, and those characteristics can change with moisture, temperature, and field wear throughout a game or season.

 

For that reason, injury prevention should be approached from multiple angles. Neuromuscular training programs, coaching education, proper strength and conditioning, and movement training are essential components. At the same time, equipment design deserves attention as well. Footwear that is designed specifically for female athletes and that thoughtfully balances traction with rotational release may help reduce the amount of injurious force transmitted up the kinetic chain.

 

As participation in women’s sports continues to grow, so does our responsibility to better understand and address injury risk. Preventing ACL injuries will require a comprehensive approach that includes athlete training, coaching education, playing surface considerations, and continued innovation in footwear design. When these factors are considered together, we have a real opportunity to help protect athletes while allowing them to perform and compete at the highest level."

- Dr. Robin West