ACL Injuries in Youth Sports: Why Females are 2-10 Times More Likely Than Males to Tear The ACL

Anterior Cruciate Ligament (ACL) injuries are a common and debilitating injury in sports, and unfortunately, youth females are more susceptible to a torn ACL compared to males. But why?

Why do we see more female athletes tearing their ACL?

What can females do to decrease their risk?

In this article, we uncover the factors behind this gender disparity and provide valuable insights into what females can do to decrease their risk. By understanding the anatomical, hormonal, neuromuscular, and biomechanical factors at play, as well as the importance of training and prevention strategies, we can pave the way for safer athletic experiences and reduced incidence of ACL tears for females.

Let’s explore these variables in more detail:

Anatomy and Hormonal Differences

There are anatomical and hormonal variations in females that affect the knee joint. With a wider pelvis, increased Q-angle, and hormonal fluctuations at the forefront, the delicate balance of ligament laxity is remarkably influenced, rendering females more susceptible to dreaded ACL tears. 

A larger Q-angle—between the hips’ natural width and the narrower knee positioning—is believed to exert greater stress on the knee compared to a more vertical alignment from the hip to the knee to the foot. This added stress, in combination with the forces already placed on the ligaments while pivoting and playing sports, can increase the risk of tear in females with a larger Q-angle. 

Hormonal fluctuations, particularly related to the menstrual cycle, is also thought to contribute to the susceptibility of ligament tears. The research has yet to confirm this theory, although many experts believe there is a correlation to some degree, even if it is not yet fully understood.

Neuromuscular Imbalances:

Neuromuscular control refers to communication between the brain (nervous system) and muscles and is responsible for actions such as reacting to a stimulus or controlling body movement. Neuromuscular control deficits are more evident in youth females compared to their male counterparts…and these imbalances can create a perfect storm for injury.  Most frequently seen is a relative weakness in the hamstrings compared to the quadriceps, compromised core stability, and less controlled mechanics during landing. These imbalances inflict additional strain on the ACL during dynamic movements, thereby contributing to a higher likelihood of a tear. 

While the ideal ratio of quadriceps to hamstring strength hovers around 3:2, certain females typically exhibit a range closer to 3:1. This lack of hamstring strength impedes the muscle group’s ability to contract effectively and uphold proper alignment of the knee joint—an issue notably prevalent among adolescent females. Implementing exercises to improve neuromuscular imbalances are crucial to decreasing injury risk. 

In scenarios where the core, hamstrings, and hip stabilizing muscles lack sufficient strength and stability to sustain optimal joint alignment, female athletes subject their knees to substantial forces while executing cutting, pivoting, and landing maneuvers. A force on the ACL that is greater than its capacity will result in a ligament injury. 

Biomechanical differences:

Biomechanical differences in females can alter optimal sport specific movements such as landing mechanics. A prevalent occurrence among females is the heightened tendency towards knee valgus—an inward collapse of the knee—during actions such as landing or cutting. This alignment places excessive strain on the ACL, amplifying the likelihood of injury. 

Research also suggests that women may have relatively smaller and weaker ACLs compared to their male counterparts. This dissimilarity in size and strength holds the potential to compromise the ligament’s capacity to withstand the forces encountered during dynamic movements, consequently rendering it more vulnerable to injury.

Sports participation and injury risk:

Engagement of females in high-risk sports like soccer, basketball, gymnastics, and skiing, significantly increases the occurrence of ACL tears. These sports, characterized by activities 

such as cutting, planting, pivoting, and landing, inherently elevate the vulnerability to injury. 

Compounding the issue is the fact that many young females partake in these higher-risk sports without proper training or preparation, further amplifying their risk.

Training and Prevention Strategies:

Training opportunities and injury prevention strategies may not be accessible for all athletes. It is crucial for female athletes to have access to specialized training programs that prioritize enhancing neuromuscular control, strength, and proper movement mechanics when they begin to participate in sports, because even the right exercise, done the wrong way, can actually make you more susceptible to injury.  

Historically, males have had the advantage of strengthening at an earlier stage, leading to a reduced risk of injury in their career. When female athletes are afforded the same opportunity to strengthen and train their bodies, they experience a decrease in the risk of injuries as well. 

So…How do I reduce the risk? 

Understanding the contributing factors to the heightened susceptibility of ACL tears gives female athletes the ability to proactively implement measures to prevent such injuries. (For more insight, you can download the FREE Report on Why Injury Prevention Programs are ESSENTIAL for Female Athletes Pursuing a College Sport.)  

By emphasizing the significance of tailored training, promoting neuromuscular equilibrium, and implementing injury prevention strategies, females are empowered to mitigate their risks and pursue their athletic aspirations with unwavering confidence.

At ACL Strong, We have cultivated a safer and more inclusive sporting environment for female athletes by creating a plan that will decrease injury risk and bulletproof your knees!
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