Anterior cruciate ligament (ACL) injuries are the most common knee injury for athletes, both male and female. However, there are more ACL injury occurences in female athletes. According to the American Orthopedic Society for Sports Medicine, there are about 150,000 ACL injuries the United States per year. About 70 percent of the injuries occur in athletes during actions such as pivoting, cutting, sidestepping, or awkward landings. 30 percent of ACL injuries occur from contact with other players. ACL injuries are most common in sports that require sudden changes of direction, such as soccer, basketball, tennis, and football.
The ACL is one of the four main ligaments in the knee that connects the tibia to the femur. This ligament runs through the middle of the knee and it prevents the tibia from sliding in front of the femur. It aslo provides rotational stability to the knee. When the ACL tears, the knee usually pops, and the knee buckles and gives out.

After the ACL is torn, the orthopedic surgeons usually recommend an ACL reconstruction surgery. During this reconstruction, the patient has a choice to have his/her ACL replaced by a tendon in his/her body or a cadaver. With intense physical therapy, the recovery time of this process is six months; however, many people return back to their activities after a full year of training and physical therapy.
Caroline Doty, a former University of Connecticut girls’ basketball point guard, has torn her ACL three times in four times. The first time she tore her ACL, she was playing soccer in high school. Her teammate “passed her the ball, she turned, and an opponent slid under her knee” (Longman). The second time she tore her ACL she was a freshman at UCONN. Caroline Doty was driving in for a layup against Syracuse, and she landed awkardly. This is a very common way in which the ACL is torn. It is usually nokcontact present when the ACL is being torn. The final time was during practice going through a one – on – one drill. When she went up for a layup, Doty “felt her left knee shift when she landed” (Longman) .
When participationg in activites, such as jumping and cutting, female athletes are automatically expected “to depend less on their quadriceps, which pulls the shinbone forward, tightens the ACL and create a shearing force” (Longman). On the other hand, men tend to focus more on the hamstring when they land. This provides an opposing force.
After a continuation of torn ACLs in University of Connecticut girls’ basketball players, trainers started talking to the players about the little things tht they can do to prevent the ligament tear. The players are taught to bend at the hips and knees to softly absorb the load, “keeping their knees behind the toes, striking the ground toe to heel” (Ragle). One of UCONN’s basketball rules includes the positioning of the pplayer receiving the ball. If you cannot pass the ball before your teammate reaches the opponent’s side free throw line, do not attempt to pass the ball to avoid a sudden stop. Sudden stops are one factor that contributes to the abterior cruciate ligament.
More and more females are beginning to participate in sports and other intense activities. Correlating with the increased number of female athletes is the increased occurrences of ACL injuries in female athletes. Young ladies are “two to ten times more liekly to sustain a knee injury” (Hewett) than boys. There are several different reasons for this evil trend. Anatomy of the knee, hormonal changes, and biomechanic differences are just a few examples of why female athletes are at a greater risk than male athletes to tear their ACL.
There are numerous anatomical and structural differences between males and females. In females, the ACL is smaller and more lax or loose than males. This contributes to why the ACL is more prone to tear in a female’s knee. A shorter ACL may have less ability to stretch than a longer ACL. Not only do the differences in the ACL itself contribute to the issue, but the surroundng ligaments and bones have something to do with it also. For example, women have a wider pelvis, which is associated with the hip, than men. This makes the thighbone angle more downward than men. The greater the angle, the more pressure that is applied to the inside of the knee, which enchances the possibility of one tearing their ACL.
The Q or quadricep angle is a measurement of the angle between the quadriceps and the patella tendon, and it provides vital information about the alignment of the knee. The normal Q angle for men is 14 degrees and for women is 17 degrees. As mentioned before, women usually have a higher Q angle because of their naturally wider pelvis.
Another anatomical difference is the size of the intercondylar notch. Females have a narrower intercondylar notch than males. If this notch is too narrow or small, it limits the space in which the anterior cruciate ligament can move causing extra stress on this ligament hich leads to a torn ACL. Also, because there is not much room to move, the femoral condylars can more easily pinch the ACL during twisting and hyperextension movement. If the ACL is pinched, it is ore than likely to tear. The intercondylar notch is typically larger in men, which gives their ACL more room to move freely.
The intercondylar notch is the deep groove or notch between the condyles of the femur or thighbone. In females, the average intercondylar notch width is 13.9 ± 2.2 mm and 15.9 ± 2.5 mm for men.
Another factor that contributes the fact that women are more prone to tear their ACL than men is the hormonal changes. Hormones are a huge factor of the ligament elasticity in females and not in men because hormones change constantly while females are on their menstrual cycle. The hormones cause the elasticity to decrease and this less elasticity means less range of motion. The ligament is now at a greater risk at tearing.
According to Slauterback, about 60 percent of females that tore their ACL reported that they were on their mestrual cycle at the time. A recent study says that the changes in estrogen levels during a female’s menstrual cycle affects ACL strength, making susceptible women to the higher ACL injury rate. A study in 1998 on the impact of hormones on ACL injuries in female athletes revealed that more ACL injuries occurred than expected during the ovulatory phase of the menstrual cycle when estrogen levels are high as compared to the luteal and follicular phase.
Biomechanical differences in males and females play a huge role in the study of why females are more likely to injure their ACL than males. The higher risk in girls do not occur until she reaches puberty because of the increase if estrogens that are produced in her body. In puberty, males experience an increase of testosterone; which aids the building of the muscle. On the other hand, females experience an increase of estrogens, which makes tendons relaxed. Although this may be a tiny factor in why females are more susceptible than tearing their ACL than men, research shows that this is not a vital reason. According to a 2007 article in the British Journal of Sports Medicine, there has been “no conclusive evidence directly linking an increase in ACL injury to a predictable time in mestrual cycle” (Silvers, Mandelbaum)
Next, there is the issue of muscle strength. A man and woman may be competing in the same activity with equal force on their knees, but the woman is more prone to a knee ligament injury. This is because of the different weight and pressure the different knees can handle. Women have less muscle strength in their knees due to the difference in bone size. Therefore, females rely more on the support of their ACL for knee stability than the muscles because of the lack of strength. This makes the ACL more prone to tear.
Because of the differences in muscle strength, female athletes depend more upon their ACL than men. According to Endurance Orthopedics and Sports Medicine, the muscles that keep the knee in place are stronger in males than in females, and women have less muscle strength in proportion to bone size. Another example of the two genders using their muscles differently is the different uses for certain movements. A male is more likely to use his hamstring muscle to slow down or stop, whereas, a female is more likely to use her quadricep muscle.
In addition to the hormonal changes in females and the anatomical differences of the knee, biomechanical differences are a suggested reason why female athletes are more prone to tearing their ACL than a male athlete. Women tend to have a greater imbalance between the quadriceps and the hamstring. The quads are stronger and more reliable in females, whereas males depend more on their hamstrings. Depending more on the quadriceps and none on hamstrings can lead to knee injuries. The quads along cannot control nor support the valgus motion well. When a female athlete flexes and overuses her quads, she is pulling her tibia forward, which puts a greater amount of pressure on the anterior cruciate ligament.
There is also a biomechanical differences between the way females and males land on their feet from a jump or from running. The correct landing movement should be an upright torso position, and the knees should be slightly bended so that other parts can absorb some shock instead of all of it going directly to your knees. When one jumps, the knees should be be forward and bent. This “allows your thighs and calves to help absorb the landing equally, taking much of the force off of your knee joints.”
Another reason female athletes are more prone to tearing their ACL is because of the anatomical reasons. Females, during their post-puberty stage, are more likely to be knock-kneed, have weaker hip bones, and have dominant quadriceps instead of hamstrings. Because of this, females stand more upright with knees extended when they land or make quick movements, actions that may stress the anterior cruciate ligament (ACL).
Females land from the air in the most incorrect way. They tend to land in an upright position because of weaker hamstrings. Landing in this position results in the over amount of pressure to the knee joints. Males come back to the ground in a more bent position. This decreases the amount of force that is put onto your knee joints, and it also decreases the risk of injuring the knee.
More research was done concerning how the landing of female athletes contributes to the increasing numbers of torn ACL’s in female athletes. Marc Norcross analyzed 82 physically healthy mean andwomen using motion analyzing software to determine exactly how they landed from a jump. He discovered in his research that women are “3.6 more likely to land in a knock – kneed position” ( Norcross). Women have wider, making it more likely that their knees come together after jumping.
Another issue with a female’s position of landing is how they land on their feet. It is said to be that one major reasons that any athlete iffers an ACL injury Is because of a flat-foot landing instead of landing on the balls of their feet. Dr. Boden staes, “If the calf muscles are not absorbing the force, and if the knee is not in the proper position, the knee buckles and tears the ACL.”
Improper landing could result in the tearing of one’s ACL. “The Fremont Area Medical Center notes that 70 percent of all ACL injuries occur when landing from a jump” (Ipatenco). Landing with your knees bent will help reduce your risk of tearing your ACL, and it will also help strenghten your hamstrings.
An anterior cruciate ligament (ACL) tear is seen more in a female athlete than a male athlete. Research shows that females are at a much higher risk to tear than ACL than men. This is because of the anatomical differences, hormonal changes, and biomechanical differences of men and women.
The sizes of structures in females’ body are a big reason why they are more susceptible to an ACL tear. For example, the intercondylar notch, pelvis cavity, Q angle, and actual anterior cruciate ligament itself all contribute to the reasons why it easier for female athletes to tear their ACL than men.
The hormonal changes in females are believed to be on of the reasons also. According to my ACL doctor, Dr. Robert Sawyer, “ the menstrual cycle is not a direct cause of an ACL tear. However, the estrogens that are being released during this time put the ligament at a greater risk of tearing. Testosterone, or “low T” is a sex hormone in males, similar to the estrogen in females. Low T helps the ACL to stay strong because it strengthens muscles and ligaments throughout the body.
The biomechanical differences in females and males are also one of the causes of females tearing their ACL more than boys. The biggest issue is the movemnet of the knee when they pivot, jump, or land. Females tend to land from a jump in an upright position, while males usually land in a position with their knees bent. This is because of the simple difference of muscle strength aroung the knee.
As seen in research, because women are made up different than men and have different things going on in their body, they are more prone to an ACL injury than men. Although men do still have ACL injuries, women are much likely to suffer through this particular journey. The research that has been completed is aiding doctors all around the world to decrease this evil trend. More and more physical exercises and training programs to help reduce one’s chance of tearing the ligament has been introuduced to the public. These advancements will inform the athletes correct motions and movement that do not strain the anterior cruciate ligament. Therefore, although females cannot avoid tearing their ACL, they can lower the risk of them having the injury.