ACL Tears: The injury more common among female athletes

Women’s sports have never been as exciting as they are right now, whether at the high school, college, or professional level. But along with the thrills on court or field come the inevitable anterior cruciate ligament (ACL) tears and other orthopedic injuries that are more common among women than men. Estimates of women athletes’ ACL injuries range from two to six times greater than that of male athletes. The peak ages for these injuries is 15-19, according to the American Medical Society for Sports Medicine


The ACL is one of two ligaments inside your knee that control the front and back motion of the knee. The ligaments cross with the ACL in front and the posterior cruciate ligament (PCL) in back. 

The ACL connects the femur or thigh bone to the tibia or shin bone, providing rotational stability to your knee. The PCL is the stronger of the two ligaments and works to keep the shinbone from moving backward too much.


A torn ACL can be caused by:

Usually, it is the abrupt force of impact from fast movements like a twist to quickly change directions in soccer or landing a jump from a layup in basketball that causes the tear.


When asked why women experience more ACL tears than men, Emily Harold, MD, a sports medicine physician at University of Utah Health’s Women’s Sports Medicine Clinic, says, “This has been a very hot research topic for 20 years because there are all kinds of theories why women tear their ACL more than men. One of the reasons is that women tend to have less hamstring and gluteal muscle development. So, when women jump, they often land in positions that place more stress on the ACL, which can make it more likely to tear.”

Harold also says that, because of estrogen, women’s ligaments tend to be less stiff with more laxity, and therefore more flexible. Recent research indicates more injuries may be likely during the higher estrogen levels of a woman’s menstrual cycle, according to an article in Frontiers in Physiology and other research.

“Also, we have discovered recently that women tend to have a smaller notch in their femur where the ACL attaches,” Harold says. “And that smaller notch has been shown in both men and woman to increase your chance of ACL tearing.”


For athletes, ACL reconstruction is the recommended treatment to add stability back to the knee. “You cannot take the ligament that’s been torn and sew it back together,” Harold explains. “You have to rebuild a new ligament. The most common method is using part of the hamstring, but we can use part of the patellar tendon or a cadaver graft, which is a graft from another person.”

The recovery period before an athlete can return to their sport is typically nine to 12 months, with physical therapy post-surgery. “When you reconstruct the ACL, you have to let it heal before you can stress it,” Harold says. “After surgery, we start really slowly with walking, biking, and eventually some running.”

For older women who don’t participate in high-intensity sports, physical therapy may be adequate treatment. Your doctor can help you decide which treatment is best.


The higher level of activity, the higher risk of reoccurrence of an ACL tear—whether you have had reconstructive surgery or not. But, by teaching women and girls how to better land jumps, use their hamstring muscles more, and increase hip and core strength, ACL tears can be reduced by half.

“A lot of the work with ACL jump training is actually getting women athletes to jump and land in a safe position so less stress is placed on the ACL,” Harold says. This is accomplished through individual and group strengthening and jumping programs.

In short, working to develop muscle groups evenly and working on both strength and flexibility as well as proper landing techniques can help avoid those injuries on the field or court that have become so common as more women play competitive sports.