Female athletes are three times more likely to suffer from anterior cruciate ligament (ACL) tears than their male counterparts, new research shows.
That’s the key conclusion of a new analysis of studies of gender differences in ACL ruptures, among the most common knee injuries, published in the Journal of the American Academy of Orthopaedic Surgeons.
Lead researcher Karen Sutton, M.D., an assistant professor at the Yale University Department of Orthopaedics and Rehabilitation, said the review points up the need for sports training programs and reconstructive ACL surgery to focus on the unique characteristics of female knees that make them more prone to injury.
"As female athletes have increased their participation in sports, many studies have shown the vulnerability of female athletes to ACL ruptures," said Dr. Sutton. "This devastating injury has a long recovery period and a slow return to sport. Thus, research has been done focusing on why women are more vulnerable to ACL injuries and how to prevent them."

The ACL is one of the four main ligaments in the knee that connect the upper (femur) and lower (tibia) leg bones. Dr. Sutton said unique anatomical differences in the female knee likely contribute to higher injury rates.
For instance, females have a larger “quadriceps angle” — the angle at which the femur meets the tibia — than males that may cause a greater pull of the knee muscles during physical activity, and contribute to more ACL injuries. They are also more likely to have a smaller, A-shaped “intercondylar notch” — the groove between the rounded ends of the femur bone — making ACL reconstructive surgery more challenging.
Dr. Sutton’s review noted multiple, recent research studies have found neuromuscular training programs that designed to improve knee stability when jumping, landing, or pivoting may significantly decrease ACL injury risk among girls and women.
"All female athletes, starting in adolescence, should learn appropriate training techniques," said Dr. Sutton. "This includes the appropriate way to land from a jump, increasing the strength of muscles that could have a protective effect on the ACL — core, gluteal, quadriceps, and hamstring muscles, as well as working on the body's reaction to change of direction and change of speed."