ACL Injuries: More Prevalent Among Female Athletes?

In Physical Therapy, Sports Performance and Injury Prevention by Elyse Schroeder, PT, DPTLeave a Comment

According to Terry Malone, PT, EdD, ATC, FAPTA in his MedBridge Education course ACL/PCL Injuries, Surgeries, and Rehabilitation, the answer is: yes

The occurrence of ACL injury in female athletes is greater than that of male athletes.  There’s evidence in the literature to substantiate this claim.  In a 1993 study headed by Malone looking at ACL injury prevalence in NCAA Division I basketball players (male vs. female), female basketball players were six times more likely than males to have a non-contact ACL injury.

But first, what is the ACL?

The anterior cruciate ligament (ACL) is a major ligament providing stability to the knee joint.  It attaches from the femur to the tibia.  It is the most commonly injured knee ligament and can be ruptured via a contact injury to the knee or without contact (such as a sudden directional change or uncontrolled landing.)  Those injured frequently report a “popping” sound at the time of injury.

Why are female athletes more at risk for ACL injury?

According to Malone, there are several factors that may put female athletes at increased risk for non-contact ACL injury:

  • Anatomy of the ACL itself.  In females, the ACL is smaller, shorter, and has more laxity and a lower failure load as compared to males.
  • Muscle weakness.  Female athletes are more likely to have hip muscle weakness, leading to poor landing position (more likely to land on stiff knees or with knees knocking together on landing).
  • Sport stance or “ready position”.  Females athletes tend to stand more upright and land on straight legs (versus “ready position” with bent knees and hips or soft landing with bent knees and hips), putting them more at risk for ACL injury.

What can we do to prevent or reduce risk of ACL injury in female athletes?

Malone offers several suggestions to mitigate risk of ACL injury in female athletes, substantiated by research studies:

  • Strengthening and endurance training
  • Balance training
  • Teaching proper jumping and landing techniques (soft landing and increasing hip and knee bend upon landing)
  • Plyometrics, including backward running
  • Start training programs as early as middle school

For female athletes, preventative training and conditioning is the key to reducing the risk of sidelining ACL injuries.  Getting an early start and maintaining a consistent injury prevention program are essential for not only ensuring continued sport participation, but also for enhancing overall sport performance.

For more information on ACL injuries, injury prevention, or to schedule a Sports Performance Enhancement and Injury Prevention Consultation, please visit: or contact [email protected] .

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