It’s become a scourge, the cause of which seems to defy both rhyme and reason. Players have torn their ACLs on wet fields and dry ones, on turf and grass, through contact and while practicing alone. When USWNT midfielder Kristie Mewis torn her left ACL in 2018, she said she was making a move she had made thousands of times in her career without incident.

That time it ended with her writhing on the ground in pain.

UEFA, European soccer’s governing body, put together a panel of experts in December in an effort to understand why women players are four to six times more likely than men to suffer from ACL injuries.

According to Dr. Mark Cullen, an orthopedic surgeon and sports medicine specialist in Portsmouth, N.H., 70% of ACL injuries in female soccer players are noncontact injuries that primarily involved one of two mechanisms: running and cutting sharply or landing on one leg that is in extension. Both mechanisms put significant strain on the ACL.

In addition, Cullen said, female soccer players are more likely to injure their nondominant leg while men tend to hurt their dominant leg.

Several theories have been offered for why that is, citing everything from a condensed match schedule, physiological differences between the genders and the way women run to a rising level of play in women’s soccer and even simple bad luck.

The number of elite players who haven’t torn their ACLs is seemingly smaller than the number who have. Megan Rapinoe torn her ACL three times. Alex Morgan ruptured hers in high school. So did NWSL teammate Jaedyn Shaw. Naomi Girma, U.S. Soccer’s female athlete of the year, tore hers in college.

None of that is likely to make Fishel feel better. After an MRI on Monday confirmed the tear, her parents drove up from San Diego to be with her that night, then drove her back to San Diego the next morning to await surgery, which will be followed by at least eight months of rehab, ruling her out of the Paris Olympics.

“I know she’ll come back strong,” Kilgore said.

There’s no way she can know that, of course. Christen Press, a two-time World Cup champion, tore the ACL in her right knee eight games into Angel City’s first season in 2022 and hasn’t played since. USWNT midfielder Catarina Macario tore her left ACL 21 months ago and only recently returned to training.

Macario was 22 when she was injured, the same age Fishel is now. But Macario had already played in 17 games for the USWNT, including in the Tokyo Olympics, and won a Champions League title with Lyon. That was what Fishel wanted when she left UCLA after three seasons and turned her back on the NWSL to play in Mexico’s Liga MX with Tigres.

It was a route no top American had taken before, but it paid off when Fishel scored 17 times in 17 games in the 2022 Apertura, becoming the first foreigner to lead the league in scoring. That earned her a three-year contract with Chelsea, the club she wanted to play with all along. That, in turn, led to this month’s call-up for the Gold Cup, where she was expected to play in a competitive match for the first time on the senior level.

“I’ve always said I want to be the best soccer player and that’s not going to happen if I’m comfortable and doing things that are easy,” she said last week. “Challenging myself is what makes me happy. If everything was the same — you know, same training, same way of life — it’s boring.

“You want something different to challenge you.”

The toughest challenge of Mia Fishel’s career is just beginning.

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