ACL Injuries: Female Athletes At Increased Risk

Strength and conditioning program may help prevent some non-contact ACL injuries

Since the passage of Title IX in 1972, girls' participation in high school sports has increased dramatically, by one estimate by more than 900%. The spectacular performance of the U.S. women in the London Olympics, along with the increase in the popularity of women's professional sports, have had a profound influence on a new generation of aspiring female athletes. "Be like Mia" has been replaced with "Be like Abby" and "Be like Hope."

The speed, power, and intensity displayed by female athletes have dramatically increased over the past decade. Such more aggressive style of play has led, predictably, to an increase in musculoskeletal injuries. One of the more common is a sprain or rupture of the anterior cruciate ligament (ACL).

Knee injuries are the most common cause of permanent disability in female high school basketball players, accounting for up to 91% of season-ending injuries and 94% of injuries requiring surgery. In the United States, 20,000 to 80,000 high school female athletes experience ACL injuries each year, with most in soccer and basketball.

ACL: vital role in many sports

Straight-ahead sports like jogging, swimming, and biking place little stress on the ACL. Sports such as lacrosse, soccer, basketball and volleyball that involve cutting, planting and changing direction, in which the ACL plays a vital role, put athletes, particularly females, at greatest risk of ACL injury.

Less than a third of all reported ACL injuries involve contact from an outside force such as an opposing player, goalpost or another object on the field/court. Over two-thirds are non-contact ACL injuries resulting from

  • One-step/stop deceleration

  • Cutting movements

  • Sudden change in direction

  • Landing from a jump with inadequate knee and hip flexion (at or near full extension)

  • Lapse of concentration (resulting from unanticipated change in the direction of the play)

Women suffer more ACL injuries

According to recent studies young female athletes are four to six times more likely than boys to suffer a serious non-contact ACL injury.

  • According to the Centers for Disease Control and Prevention more than 46,000 female athletes age 19 and younger experienced a sprain or strain of the ACL in 2006.

  • Nearly 30,000 of the injuries required reconstructive surgery.

  • Overall, girls are 8 times more likely to suffer an ACL injury than boys.

  • As many as 70% of ACL injuries involve little or no contact with the other player.

  • At the age of 14 years, girls have 5 times higher rates of ACL tears than boys.

No easy explanation

Women may be more prone to non-contact ACL injuries because they run and cut sharply in a more erect posture than men, and bend their knees less when landing from a jump.

Why women and girls are more prone to ACL injuries than men and boys defies easy explanation is also likely due to a number of anatomical and hormonal differences between men and women:


The best solution is proactive prevention with proper strength and prevention training for your athlete, so she has better stability, strength, and control on the field.

  • Proper leg muscle strength training and core training;

  • Proper neuromuscular (balance and speed) training;

  • Proper coaching on jumping and landing and avoiding any straight knee landing;

  • Proper footwear and orthotics if necessary (the amount of traction or "grippiness" of athletic shoes needs to fall within an optimal range that minimizes rotational friction to avoid injury yet optimizes transitional friction to allow peak performance in activities such as cutting and stopping)

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