Illustration of a female athlete landing, highlighting the risk factors for ACL injuries.

ACL Injuries in Women: Why Are They More Common, and What Can Be Done?

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Nico Varela in Health & Wellness October 2026 • 4 min read.

"Understanding the Rising Rates and Prevention Strategies for ACL Tears in Female Athletes"


Anterior Cruciate Ligament (ACL) injuries are a significant concern in sports, and the statistics are particularly troubling for female athletes. Research consistently shows that women are at a higher risk of ACL tears compared to their male counterparts. This article delves into the reasons behind this disparity, examining the complex interplay of factors contributing to this trend.

From hormonal influences to biomechanical differences, the article explores the multifaceted nature of ACL injuries in women. It goes beyond the causes to provide practical insights into prevention strategies, rehabilitation techniques, and the crucial role of healthcare professionals, athletes, and coaches in mitigating this risk.

This comprehensive guide aims to empower athletes, coaches, trainers, and medical professionals with the knowledge needed to understand and address the challenges of ACL injuries in women, promoting safer and more successful participation in sports.

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Why ACL Injuries Matter

ACL injuries are an important health and wellness concern for athletes and physically active people. Their likelihood and effects can vary with individual circumstances, sport demands, and access to appropriate care. The reasons women may experience these injuries more often are multifactorial, so conclusions should be interpreted carefully.

Treatment Is Individualized

ACL surgery is a complex operation requiring expertise in orthopedic and sports medicine. The choice of treatment and graft depends on factors including the athlete's level of competition, age, previous knee injury, other injuries, leg alignment, and graft choice. The source identifies four typical graft types, including the bone-patella tendon-bone graft, underscoring that no single surgical approach fits every patient.

An Evolving Field

The understanding and treatment of ACL injuries have developed over time through advances in diagnosis, surgery, rehabilitation, and sports medicine. The history is not a single linear breakthrough, and treatment decisions continue to depend on patient-specific factors. A concise historical account should therefore distinguish established milestones from approaches that remain under evaluation.

Why Are ACL Injuries More Common in Women?

Illustration of a female athlete landing, highlighting the risk factors for ACL injuries.

Several factors converge to increase the risk of ACL injuries in female athletes. These include anatomical differences, hormonal influences, and biomechanical variations. Understanding these aspects is crucial for developing effective prevention and treatment strategies.

  • Anatomical Differences: Women often have wider hips, leading to increased knee valgus (inward movement) during landing and cutting maneuvers, putting stress on the ACL.
  • Hormonal Influences: Fluctuations in hormones, particularly estrogen, throughout the menstrual cycle can affect ligament laxity, potentially increasing the risk of injury during certain phases.
  • Biomechanical Variations: Studies show that women often land with their knees straighter and use their quadriceps muscles more dominantly, increasing ACL strain.

It is important to note that these factors don't work in isolation but often interact in complex ways, making each athlete's risk profile unique.
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Evidence Continues to Develop

The supplied ACL OpenReview page is a homepage rather than a specific medical study or review. It therefore does not establish a finding about ACL injuries in women or identify a particular prevention or treatment method. Current claims about the latest research should be tied to identifiable studies and their methods rather than to a general publication portal.

Avoiding Overconfident Explanations

No single explanation should be treated as sufficient for differences in ACL injury patterns. Biological, movement-related, training, environmental, and contextual factors may interact, and evidence may not support identical conclusions across all groups. Prevention or treatment claims should therefore acknowledge uncertainty and the possibility of limited generalizability.

Comparisons Require Care

Comparing ACL injury patterns across populations requires consistent definitions, exposure measures, and follow-up. Apparent differences may reflect differences in sports, competition levels, training, reporting, or access to care rather than one cause alone. Conclusions should remain appropriately qualified when those conditions are not comparable.

Beyond these core contributors, other elements come into play. Muscle strength imbalances, inadequate training in neuromuscular control, and external factors like playing surfaces and footwear can further elevate the risk. It's a multifaceted issue that requires a holistic approach to address effectively.

Empowering Women in Sports: A Call to Action

ACL injuries pose a significant challenge to female athletes, but they are not insurmountable. By understanding the underlying causes, implementing proactive prevention strategies, and focusing on comprehensive rehabilitation, we can create a safer and more supportive environment for women in sports. This requires a collaborative effort from athletes, coaches, trainers, and medical professionals, all working together to empower women to pursue their athletic goals without unnecessary risk.

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A Patient-Centered Synthesis

A useful synthesis treats ACL injury risk and recovery as multifactorial rather than attributing outcomes to sex alone. Clinical decisions should account for the individual's injury history, goals, anatomy, and treatment options. Expert interpretation is most reliable when it separates established evidence from plausible but still uncertain explanations.

Questions for Future Research

Future work should clarify which prevention strategies work best for different athletes and settings. It should also examine how biological, mechanical, training, and healthcare factors interact over time. Stronger research designs and transparent reporting can help turn promising ideas into dependable guidance.

Beyond the Knee

ACL injury prevention and recovery are shaped not only by clinical care but also by training environments, resources, education, and opportunities to access rehabilitation. Differences in those conditions can influence who receives prevention, surgery, and follow-up support. A broader view helps avoid placing responsibility solely on individual athletes.

People Behind the Injury

The supplied ACL Member Portal source describes computational linguistics as the scientific study of language from a computational perspective, including knowledge-based and data-driven models. It does not provide evidence about ACL injuries, women's health, recovery, or patient experiences. Consequently, no specific human-impact conclusion about ACL injuries can be drawn from that source.

How the reported difference is measured

  • 2 to 10 timesA 2015 source gives a relative comparison: female athletes were reported as 2 to 10 times more likely than male athletes to injure an ACL. This is a range of relative likelihoods, not a count of injuries or a single estimate for every sport or setting.[1]

Where the reported figures and evidence come from

The epidemiology review searched MEDLINE records from 1978 to 1998 using ACL and female-athlete terms among others, placing its conclusions in a defined historical search window rather than a current census of injuries.[2]

A 2024 systematic review included female athletes in pivoting sports and reported that a majority returned to sport after reconstruction, while also describing the available return-to-sport information as insufficient and lacking quantitative data and reasons for not returning. This is recovery evidence, not a direct test of why injury rates differ by sex.[3]

In that review, soccer was the most common sport among included athletes. The findings therefore reflect a participant group in which soccer was especially represented, rather than an even sample of sports.[3]

The next questions these findings leave open

  • How much does the reported relative difference change across sports, competition settings, and definitions of injury? The available comparison is expressed as a range, and the epidemiology review’s sport-specific result concerns noncontact injuries in soccer and basketball.[1] [2]

Common questions about ACL injury evidence

Does the reported sex difference apply to every sport?

The cited comparison specifies a significantly increased risk of noncontact ACL injuries among female athletes in soccer and basketball. It does not establish that the same comparison applies to every sport.[2]

Does the evidence explain why women have more ACL injuries?

The cited evidence does not settle a single explanation: a review found little convincing evidence linking static anatomical factors to noncontact ACL risk, and a muscle-response study had not yet tested a perturbation mimicking the injury mechanism.[4] [5]

Sources

  1. Anatomic Factors that May Predispose Female Athletes to Anterior Cruciate Ligament Injury (Current Sports Medicine Reports, 2015)
  2. Anterior cruciate ligament injury in female athletes: epidemiology. (PubMed, 1999)
  3. Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis (Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine, 2024)
  4. Anterior Cruciate Ligament Injuries in Female Athletes: Anatomy, Physiology, and Motor Control (Sports Medicine and Arthroscopy Review, 2002)
  5. Investigation of female lower limb muscle reaction to multidirectional perturbation (2018)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.csm.2017.05.004, Alternate LINK

Title: Update On Anterior Cruciate Ligament Rupture And Care In The Female Athlete

Subject: Physical Therapy, Sports Therapy and Rehabilitation

Journal: Clinics in Sports Medicine

Publisher: Elsevier BV

Authors: Jeremy M. Burnham, Vonda Wright

Published: 2017-10-01

Everything You Need To Know

1

What are the main reasons why women are more prone to ACL injuries compared to men?

Women experience ACL injuries more frequently due to a combination of factors, including anatomical differences where wider hips lead to increased knee valgus, hormonal influences such as estrogen fluctuations affecting ligament laxity, and biomechanical variations like landing with straighter knees and dominant quadriceps use which increases ACL strain. These elements often interact, creating unique risk profiles for each athlete.

2

How do anatomical differences contribute to the higher incidence of ACL tears in female athletes?

Anatomical differences, specifically wider hips in women, often result in increased knee valgus during activities such as landing and cutting. This inward movement of the knee places additional stress on the Anterior Cruciate Ligament, predisposing female athletes to a greater risk of ACL injuries. This is just one factor, and other elements need to be considered for a full understanding.

3

In what ways do hormonal fluctuations affect ACL injury risk in women, and what phases are women at highest risk?

Fluctuations in hormones, particularly estrogen, throughout the menstrual cycle can affect ligament laxity, potentially increasing the risk of ACL injury during certain phases. Research suggests that higher levels of estrogen may lead to increased joint laxity, making the ACL more vulnerable to tears. Understanding these hormonal influences is crucial for tailoring training and prevention strategies to mitigate risk during specific times of the month.

4

What role does landing technique play in the disparity of ACL injuries between male and female athletes?

Landing technique is a significant factor. Studies suggest that women often land with their knees straighter and rely more on their quadriceps muscles compared to men. This landing pattern increases the strain on the Anterior Cruciate Ligament, making it more susceptible to injury. Training programs focused on improving landing mechanics and neuromuscular control can help reduce this risk.

5

What comprehensive strategies can be implemented to reduce ACL injuries in women, and what is the importance of a collaborative approach?

Reducing ACL injuries in women requires a multifaceted approach that includes understanding anatomical differences, managing hormonal influences, and correcting biomechanical variations. Implementing proactive prevention strategies such as neuromuscular training, strength conditioning, and proper landing techniques is essential. A collaborative effort from athletes, coaches, trainers, and medical professionals is crucial to create a safer and more supportive environment, empowering women to pursue their athletic goals without unnecessary risk. Addressing muscle strength imbalances and external factors like playing surfaces and footwear are other elements that form a more holistic and effective injury reduction program.

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