Why Female Athletes Are More Prone to ACL Tears Than Their Male Counterparts

The anterior cruciate ligament (ACL) frequently appears in sports news, often associated with injuries to pro athletes. ACL tears are one of the most common sports injuries, and one surprising fact is that women suffer from these as much as eight times more than male athletes.

A central connection between the thigh and the shin, the ACL is an important stabilizer, anchoring the orientation of the leg bones and controlling rotational stability. As knee pain specialists, we see plenty of ACL tears at  360 Orthopedics in Sarasota, Venice, and Lakewood Ranch, Florida. 

Let’s examine the reasons why women experience ACL tears so often. It comes down to a mix of Anatomy, biomechanics, hormones, and neuromuscular considerations. 

Anatomy

Women’s bodies have the capability of carrying a child and giving birth. One of the differences in anatomy compared with men is the proportionally wider pelvic span.

This changes an aspect of hip-to-knee orientation called the Q-angle, short for quadriceps angle. The line between the hip and knee forms a Q-angle of about 15 to 17 degrees for women on average, or about 3 degrees steeper than in men. 

This difference creates mechanical forces in women that simply don’t exist in men. It’s another way the female body differs. 

Biomechanics

The way women move is inherently different, too. Patterns of difference in typical sports sequences are easy to spot and to measure. In basketball, for example, when women land from jumps, their knees typically flex less than men's. 

Their knees also move inward at a greater level. Motions such as cutting and pivoting are also mechanically distinct. Each of these conditions increases forces on the knees, potentially straining the ACL under load. 

Hormones

Estrogen is the primary female sex hormone, and it cycles through various levels depending on what’s happening in your body. Normal fluctuations in estrogen levels throughout the menstrual cycle can affect ligament laxity. When these changes affect the ACL, your normal knee stability could change. 

Neuromuscular considerations

As with the Q-angle, women and men differ in natural coordination and in how muscles activate, particularly under load. The quadriceps and hamstrings play a role in how the knee functions. In women, the quadriceps muscles of the front thighs tend to be stronger than the hamstrings. 

Cutting, jumping, and landing see the quadriceps firing forcefully in women with very little hamstring involvement. This allows greater forward motion of the shin bone, which negatively affects the ACL, leading to injuries and tears. 

Awareness of the factors that contribute to ACL injuries in women can help you work to prevent damage. Strengthening the hamstrings and glutes is a great place to start in off-the-field training, as well as honing your technique with direction changes and jump form. Targeted training is often effective at preventing ACL tears. 

Contact 360 Orthopedics to learn more or to seek treatment for an ACL injury. Call our nearest office to book your visit today.