JuJu Watkins Leaves March Madness With ACL Tear—and This Knee Injury Is More Common Than You Think

In a lot of ways, USC women's basketball star JuJu Watkins is one of one. She's this year's Big Ten Player of the Year, the 2024 Freshman of the Year for the U.S. Basketball Writers Association (USBWA), Women's Basketball Coaches Association (WBCA), and the Pac-12 conference, and became the fastest women's basketball player ever to reach 1,000 points in college.

The ESPY-winning athlete has quickly become a phenom in the NCAA and had full hopes of leading her team to the championship in the ongoing March Madness tournament. That is, until she experienced a season-ending injury after tearing the anterior cruciate ligament (ACL) in her right knee while playing Mississippi State in the second round of the tournament on March 24. (FYI, your ACL is *extremely* responsible for stabilizing your knee joint.)

Watkins now becomes one of the nearly 200,000 people in the U.S. who rupture their ACL each year, making it one of the most common knee injuries you can experience. So why exactly does this injury happen so often, and what does recovery after the surgery even look like? Here's what you need to know.

The risk of an ACL injury

Believe it or not, many of the world's most famous athletes have experienced an ACL injury: Tom Brady, Neymar, Kyrie Irving—the list goes on and on. But, female athletes have a disproportionately high risk of tearing their ACLs. A stat that may surprise you: Studies show that women who play sports are up to 8 times more likely to experience the knee injury compared to their male counterparts.¹

Soccer legend Megan Rapinoe, Brazilian gymnast Rebeca Andrade, and basketball hall-of-famer Sue Bird are among the female athletes who have unfortunately been a part of this club—and the cases of ACL injuries, especially in women's basketball, are rising. Watkins now joins UConn's Paige Bueckers and Azzi Fudd and Notre Dame's Olivia Miles as one of the active college basketball players to experience the injury in recent years. But why is this number so high in women in the first place?

Well, studies says it's probably due to a combination of several anatomic, hormonal, mechanical, and environmental factors.² While more research is needed to fully understand the difference in risk, some theories suggest that:

• The ACL tissue is thinner in women, making it more prone to injury
• When women land on their feet after jumping, they have straighter knees and less core stability compared to men, who often land with bent knees and an engaged core, which can prevent injury
• Estrogen fluctuations during the menstrual cycle can alter the elasticity and stability of the knee joint in different stages, which can increase the susceptibility to tears

And while athletes have a higher risk of injuries, due to sudden movements, stops, or turns while playing sports, anyone can develop an ACL tear. Participating in recreational sports, landing awkwardly on your feet, or taking a misstep while walking or running are common reasons why you might tear your ACL—even if you're not moving your body as intensely as someone like Watkins.³

What can you expect during surgery and recovery?

Ask anyone who has lived through an ACL injury and they'll probably tell you that they instantly knew the moment they tore their ACL. And that's because the injury is really painful, to say the least. Symptoms often include hearing your knee "pop," followed by extreme pain, swelling, loss of motion, and weakness that makes it challenging to walk.

As a result of these symptoms, surgical reconstruction of the ACL is often the gold standard of treatment. This is also true for Watkins. In a statement posted by the USC Women's Basketball Twitter/X account, Watkins "will undergo surgery and then begin rehabilitation shortly thereafter."

The surgery itself is significantly short in comparison to the recovery time. Generally, your healthcare team will schedule a surgery within a month of you experiencing your ACL tear. This gives your body enough time to notice a reduction in inflammation and a slight increase in knee mobility. Once you're ready for surgery, the procedure only takes one to two hours to complete—which is short enough that your provider will likely send you home on the same day.

But the recovery time? That can last anywhere from nine to 12 months (or sometimes longer) to fully heal, depending on the severity of your injury and your adherence to your treatment and rehab plan. Most people can return to daily activities in about six to eight weeks, while more strenuous movement like walking or jogging becomes possible three to six months in. But for someone like Watkins, who intends to return to sports, experts say that it can take up to one year to play at a high level of competition.

Looking ahead

The road to recovery for Watkins may seem arduous, but there is some good news here. Many women's basketball players, in particular, who have lived through an ACL tear come back—sometimes even stronger than before. But physical therapy and rehab, lifestyle changes such as the RICE method (aka rest, ice, compression, and elevation), and injury prevention will be necessary is crucial for a safe and successful return to the sport. And all of us are hoping that's the case for Watkins, too.