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Are Female Athletes at a Higher Risk for Knee Injuries?

Injured. Sidelined. Off the starting roster. Words an athlete hopes to never hear during their career. A knee injury especially can be devastating for athletes at all levels. One of the most common knee injuries are anterior cruciate ligament (ACL) injuries, which account for 50% or more of all knee injuries regardless of gender.[1] Knee injuries are also among the most expensive of sports injuries due to often requiring surgeries and rehabilitation.[2] While ACL injuries occur more frequently in men’s sports, female athletes tend to be more vulnerable.

There is a challenge in pinpointing exactly what makes a female athlete more vulnerable to ACL injuries compared to their male counterparts so we turned to our research “Her Life Depends On It III” to learn more. Playing surface plays a factor, according to NCAA research, which looked into players injuries on artificial turf versus grass surfaces. This was a big contention during the FIFA Women’s World Cup in 2015 when players fought playing on artificial turf due to the higher likelihood of injury.

The NCAA’s data also analyzed injuries per sport and showed that “three of the four sports with the highest rates of ACL injuries [are] women’s sports (gymnastics, basketball, and soccer)” with the fourth sport being spring football.[3] Through further studies, we see that gender differences in the incidence of ACL injuries do not occur until after the onset of puberty.[4] While the highest numbers of ACL injuries occur in men’s sports, “females have higher rates of ACL injuries than males when exposed to the same sport.”[5]

Research also shows that the majority of female ACL tears are non-contact and are due to the force applied to the knee at the time of injury due to the athlete’s movements.[6] Many of these ACL injuries happen when the athlete plants, cuts or lands.[7] The high occurrence of non-contact ACL injuries points “to features of the athlete’s movements and not the circumstances of the sport” as the primary cause of injury. With this knowledge, the possibility of prevention through training is possible.

A lot of research has been done to look into why females are at a greater risk than males for sustaining a non-contact ACL injury. Through studies it appears that females perform “riskier neuromuscular patterns more often than men when doing similar sporting moves.”[8] While this is unfortunate, this area also offers the greatest potential for modification through training.

While more research is needed to dive deeper into the landing techniques and neuromuscular recruitment patterns employed by female athletes, there are certain external risk factors that can be taken note of early on to prevent injury. One risk factor is the type of shoe one chooses and how it

interacts with the playing surface, keeping in mind weather changes.[9] Another factor to note is those who have sustained an ACL injury are as a significantly higher risk of sustaining another.[10]

Injury prevention must start early, particularly around athletes adolescent years as the emergence of gender differences in joint laxity and neuromuscular control appear.[11] Coaches, team and club officials and parents must be aware of the importance of interventions to reduce injuries so that they may publicize the necessity of complying with safety-based training programs.

We all want to encourage our girls and boys to play sports and stay active but it is always important to stay safe and prevent injury where possible. A knee injury is a devastating event that can sideline an athlete for months or even permanently. Make sure you know the risks and inform your players, children or friends.

All statistics and information in this article have been obtained from our research brief, Female Athletes and Knee Injuries, sourced from the Women’s Sports Foundation study, “Her Life Depends On It III.” Read the briefs and full report here.

*Staurowsky, E. J., DeSousa, M. J., Miller, K. E., Sabo, D., Shakib, S., Theberge, N., Veliz, P., Weaver, A., & Williams, N. (2015). Her Life Depends On It III: Sport, Physical Activity, and the Health and Well-Being of American Girls and Women. East Meadow, NY: Women’s Sports Foundation.



[1] (Joseph et al., 2013)

[2] (Joseph et al., 2013)

[3] (Hootman et al., 2007)

[4] (Hewett, Myer, Ford, Paterno & Quatman, 2012)

[5] (Moses, Orchard & Orchard, 2012)

[6] (Shultz, 2008; Arendt, 2007)

[7] (Giugliano & Solomon, 2007)

[8] (Arendt, 2007; McLean, 2008)

[9] (Smith et al., 2012, part 2)

[10] (Shultz et al., 2012; Smith et al., 2012, part 2)

[11] (Hewett et al., 2012)