ACL Injury Male vs Female
What Is the ACL?
The ACL is one of four major ligaments that stabilize the knee joint. It runs diagonally through the middle of the knee and connects the thigh bone (femur) to the shin bone (tibia). Its primary role is to prevent the tibia from sliding out in front of the femur and to provide rotational stability to the knee.
How Do ACL Injuries Happen?
ACL injuries usually occur during activities that involve:
Sudden stops or changes in direction
Pivoting with a foot firmly planted
Jumping and landing
Direct blows to the knee (such as during a tackle)
Female VS Male
Neuromuscular imbalances, posture and movement mechanics, and hormonal influences contribute to higher ACL injury risk in females
Anatomical Differences
Wider Pelvis and Increased Q-Angle: Women typically have a wider pelvis, leading to a greater valgus position of knee. This alignment can increase stress on the knee joint, making it more susceptible to ACL injuries.
Smaller ACL Size: Studies have shown that females often have smaller ACLs compared to males, which may contribute to a reduced capacity to withstand mechanical stress.
Hormonal Influences
Estrogen and Progesteon Effects: Fluctuations in estrogen and progesteron levels during the menstrual cycle can affect ligament laxity. Elevated estrogen levels have been associated with decreased collagen synthesis and increased ligament laxity, potentially compromising ACL integrity.
Menstrual Cycle Phases: Research is ongoing to determine if specific phases of the menstrual cycle correlate with higher ACL injury risk. Some studies suggest increased laxity and injury risk during the ovulatory phase when estrogen peaks.
Biomechanical and Neuromuscular Factors
Landing Mechanics: Female athletes often exhibit different landing mechanics, such as less knee and hip flexion and increased knee valgus (inward collapse), which can elevate ACL strain during activities like jumping and cutting.
Muscle Activation Patterns: Females may rely more on quadriceps activation with delayed hamstring co-activation during dynamic movements. This imbalance can increase anterior tibial translation, placing additional stress on the ACL.
ACL injury prevention and rehab
While some ACL injury risk factors—such as differences in anatomy — are not modifiable, others can be addressed through targeted intervention. Engaging regularly in evidence-based prevention programs has been shown to significantly reduce the risk of ACL injuries, particularly in female athletes. These programs should include a combination of strength training and neuromuscular control exercises. Additionally, hormonal contraceptives may influence the hormonal profile during the menstrual cycle and have been associated with a potentially lower risk of ACL injuries in female athletes. It is important to consult with your physician to determine whether this option is appropriate for you.
References:
Herzberg SD, Motu’apuaka ML, Lambert W, Fu R, Brady J, Guise J-M. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2017;5(7). doi:10.1177/2325967117718781
Saber B, Bridger D, Agrawal DK. A Critical Analysis of the Factors Contributing to Anterior Cruciate Ligament Injuries in Female Athletes. J Orthop Sports Med. 2024;6(4):203-209. doi:10.26502/josm.511500163
Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg. 2013;21(1):41-50. doi:10.5435/JAAOS-21-01-41
