The Gryphon Gazette

By: Casey L. ’28

One of the most common and dreaded injuries in women’s sports is tearing the anterior cruciate ligament (ACL). Sports like basketball, soccer, and football are the most prone to ACL tears due to sudden stops, pivots, and jumps. The ACL is a small ligament inside the knee that helps stabilize the joint and prevent excessive forward movement of the shinbone relative to the thighbone.

Although an ACL tear can happen to anyone, female athletes are two to eight times more likely to tear their ACL than male athletes, even when playing the same sports. This is the case not because of bad luck, but because of anatomical differences, hormonal influences, biomechanical patterns, and training environments. 

Female and male athletes are not built exactly the same, and some of those differences can put more stress on the ACL, in turn, making female athletes more prone to ACL tears. On average, women have a wider pelvis than men, which increases the angle at which the femur (thigh bone) meets the tibia (shin bone). This results in a large Quadriceps Angle(Q-angle). A larger Q-angle can cause the knees to tilt inward, straining the ACL during sharp movements. For instance, cutting, landing from a jump, or a quick change in direction. Inside the knee joint, the ACL runs through a bony groove called the intercondylar notch. Studies show that women tend to have a narrower notch than men, which leaves less room for the ACL. This could increase the likelihood of the ligament rubbing against the bone and becoming damaged. In addition, female ACLs are typically smaller in cross-sectional area compared to those of men, even after accounting for body size. Smaller ligaments can be more prone to tearing even with the same amount of force.

Another factor that is often overlooked is hormonal fluctuations. Female athletes experience higher levels of estrogen, which can interrupt muscle function and ligament strength. Naturally, during the menstrual cycle, estrogen levels are higher. Estrogen reduces the stiffness and strength of ligaments, making them susceptible to stretching or tearing. Thus, research has found that ACL injuries are more common during the menstrual cycle because hormone changes may alter muscle control and joint stability.

One common pattern seen when watching replays of ACL injuries in slow motion is that they occur during non-contact situations. For example, a player lands from a jump or plants a foot to pivot, and the knee collapses inward. Studies have proven that female athletes tend to land with their knees straighter and collapse inward in comparison to their male counterparts. This knee position increases strain on the ACL. In addition to landing mechanics, hip and core strength are other factors. Weaker hip abductors and core muscles can make it harder to control the alignment of the knee during movement. This weakness can result in excessive inward rotation of the femur, adding stress to the ACL. Men often activate their hamstrings sooner during sudden stops or landings, which protects the ACL by reducing forward movement of the shinbone and stabilizing the knee joint against sudden forces. Women rely more heavily on their quadriceps, causing the shinbone to pull forward and strain the ligament. 

Lastly, training and environmental factors should be taken into account. Unfortunately, many female athletes have trained under programs specifically designed for male athletes, without addressing the risks they face. One program that has been shown to reduce ACL injury risk by over 50% is outlined to strengthen the hips, hamstrings, and core, as well as teach proper landing and cutting mechanics. In addition, playing the same sport all year, especially on hard indoor surfaces, can cause muscle fatigue and increase injury risk. This is especially true for female athletes in high-impact sports such as basketball and soccer.

ACL tears are one of the most dreaded injuries because they are “season-ending” and can affect one’s career in the long run. Recovering from this injury often takes 9-12 months. Even after surgery, the risk of reinjuring it is high. In fact, around 87% of athletes try to return to their sport after around five months, but nearly 7% experience tearing the ACL again, and 24% face reinjury within a few years. Even after surgery, the risk of reinjury remains alarming, especially for athletes who return too soon. A study has found that 14% of athletes who were cleared by professionals still suffered a second ACL injury. 

Female athletes who suffer from ACL injuries also face a higher risk of developing early-onset osteoarthritis in the knee. This condition affects the joint and causes chronic pain and stiffness. This risk exists for both surgical and non-surgical cases, meaning that surgery does not eliminate it. The main reason is that ACL injuries often cause damage to other parts of the body, and not just the ligament itself. For instance, these types of injuries can also affect the cartilage and meniscus, which serve as shock absorbers in the knee. Even after the ligament is reconstructed, the initial trauma and altered mechanics can accelerate cartilage wear, leading to arthritis earlier than expected. 

Research has shown that ACL injury risk can be reduced with awareness and the right preparation. Here are some tips:

• Strength Training: Building hamstring and hip strength to stabilize the knee
• Neuromuscular Training: Practice proper landing, pivoting, and cutting mechanics
• Balance: Use single-leg exercises and stability drills to train joint control
• Rest and Recovery: Avoid burnout and overtraining by taking breaks between sports seasons
• Cycle Awareness: Some athletes and coaches are tracking menstrual cycles to adjust training loads during higher-risk phases.
  

The higher rate of ACL injuries in female athletes is not about weakness or inability; it is about biology and biomechanics. Understanding these factors helps design better training, improve injury prevention programs, and ensure that female athletes can compete with reduced risk.