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Every year, thousands of athletes suffer from ACL (anterior cruciate ligament) injuries — a devastating setback, especially for those in high-intensity sports. Surprisingly, women are up to 8 times more likely to experience an ACL rupture compared to men. This gender disparity has puzzled researchers, coaches, and medical professionals for decades. But over time, science has shed light on the complex reasons behind it.

Let’s break down why ACL injuries are more common in women, and what can be done to help prevent them.

1. Anatomy Matters

Women and men are built differently, and those anatomical differences impact knee stability:

  • Wider pelvis: Women tend to have a wider pelvis, which affects the angle of the femur (thigh bone) as it meets the knee — known as the “Q-angle.” A greater Q-angle can lead to more stress on the ACL.
  • Smaller ACLs: On average, women have smaller ACLs and narrower intercondylar notches (the groove in the femur where the ACL sits), which may make the ligament more susceptible to injury.

2. Hormonal Influences

Hormones, particularly estrogen, may play a role in ligament laxity. During certain phases of the menstrual cycle, estrogen levels rise and can affect the strength and elasticity of ligaments. While the exact relationship is still being studied, some evidence suggests that hormonal fluctuations can make the ACL more vulnerable to injury at specific times of the month.

3. Neuromuscular Control Differences

Women often exhibit different patterns of muscle activation and control during movement, especially in sports involving cutting, jumping, and pivoting.

  • Quadriceps dominance: Women tend to rely more on their quadriceps than hamstrings when jumping or landing. Since the hamstrings help stabilize the knee and reduce strain on the ACL, this imbalance can increase injury risk.
  • Less knee flexion: Female athletes often land from jumps with less knee bend, creating more impact on the joint and stressing the ACL.
  • Poor hip control: Weakness in the glutes and hips can cause the knees to cave inward during movement — a position strongly linked to ACL injury.

4. Biomechanics and Movement Patterns

Research has shown that female athletes tend to:

  • Land with knees closer together (knee valgus position)
  • Rotate their knees inward more during pivoting
  • Have less core stability, which affects lower-body alignment

These movement patterns place abnormal stress on the ACL, especially during high-speed sports like soccer, basketball, and volleyball.

5. Footwear and Playing Surfaces

There’s also evidence that footwear and surface type can interact with biomechanical risks. Women may be more likely to wear shoes that don’t provide optimal support for lateral movement, and in some sports, they may play on different types of surfaces compared to men.

Prevention: What Can Be Done?

The good news? ACL injury risk can be reduced — significantly — with targeted prevention programs.

Neuromuscular training focused on:

  • Strengthening the hamstrings, glutes, and core
  • Improving balance and proprioception
  • Teaching proper landing and cutting techniques
  • Increasing overall flexibility

Programs like the FIFA 11+ and PEP (Prevent Injury and Enhance Performance) have shown success in reducing ACL injuries in female athletes.

Final Thoughts

ACL injuries are more common in women due to a complex interplay of biological, hormonal, and biomechanical factors. Understanding these risks allows athletes, coaches, and healthcare providers to take proactive steps to reduce injuries and keep women safely in the game.

Whether you’re a competitive athlete, a weekend warrior, or a parent of a young player, awareness and prevention are key. The knee may be vulnerable, but with the right training, we can reduce the rates of ACL ruptures in female athletes. 

Meniscus injuries are some of the most common injuries that we see in orthopaedic sports medicine clinic. These knee injuries can occur in athletes or as the result of traumatic injuries, or they can appear gradually over time as more of a “wear and tear” injury. So what exactly does it mean to have a “torn meniscus”, and what should you do if you think you have one? 

First, let’s start off with the anatomy. In the knee joint there are two meniscii, a medial meniscus on the inside of the knee and a lateral meniscus on the outside of the knee. These structures play a very important role in maintaining the overall health of the knee joint. The meniscus is a C- shaped structure that acts as an important shock absorber and distributor of hoop stresses inside the knee joint itself. These stresses occur when walking or running as the femur bone (thigh bone) articulates with the tibia bone (shin bone). The medial and lateral meniscus play a crucial role to protect the cartilage that lines the ends of the bones, and these structures also act as secondary stabilizers in the knee joint.

When the meniscus is not torn and is working appropriately, you wouldn’t know that it’s there! However, when the meniscus does sustain an injury that results in tearing, it can quickly become very painful. Meniscus tears can be divided into two categories. Acute tears are the result of a specific injury (often a twisting injury or fall), while chronic degenerative tears occur slowly over time, and gradually become more painful. 

Common symptoms that you might experience in your knee if you have a meniscus tear include occasional sharp, stabbing pain, along with feelings of catching, clicking, or locking. In some cases, patients report feeling like their knee is “giving way” on them. Meniscus tears are not visible on x-ray, and the imaging study of choice for diagnosis is an MRI.

If you think that you may have a meniscus tear, it is important to see a sports medicine physician, ideally someone who treats these injuries frequently and has a lot of experience reading and interpreting MRI studies. There are many different types of tear patterns when it comes to meniscus tears- many tear patterns do very well with nonoperative management such as physical therapy, but some tear patterns do better with surgical treatment. Do not hesitate to seek treatment if you are experiencing knee pain! 

February 2025

As an orthopaedic sports medicine physician, I am often asked if endurance sports are bad for the long term health of patients’ knees, and it is a question that I find extremely interesting. Many patients and physicians have been told that running long distances is bad for their knees. Historically, there has been concern that osteoarthritis (OA) is a “wear and tear” condition, and that running long distances can speed up the progression of cartilage loss in the knees. However, recent studies may call this way of thinking into question. 

A study published in 2017 found that recreational runners had a lower prevalence of osteoarthritis than both sedentary controls and elite athletes (https://pubmed.ncbi.nlm.nih.gov/28504066/). Another study published in 2024 looked at the prevalence of hip and/or knee arthritis in marathon runners, and did not identify any association between cumulative running hours and risk of OA. In this particular cohort, a history of hip/knee injuries or surgery, advancing age, family history, and elevated body mass index (BMI) were risk factors for arthritis. (https://pubmed.ncbi.nlm.nih.gov/37555313/).

Another 2024 study looking at MRI scans of running athletes compared to sedentary controls found that the running athletes exhibited significant increases in thickness of both the femoral medial articular cartilage and the tibial medial articular cartilage. This suggests that long-term mechanical stress from running may lead to positive adaptive changes in the cartilage of certain regions in the knee. (https://pubmed.ncbi.nlm.nih.gov/39144037/). 

In summary, recent evidence suggests that under the right conditions, running can actually be beneficial for cartilage in the knees- and that’s not to mention the innumerable other health benefits of running. It is important to note, of course, that if a patient already has damage to the cartilage or bone in their knees that running on an injured extremity can make it worse. It is important to weigh the risks and benefits of running long distances for each individual athlete, and to stay up-to-date on the current literature! 

Links to articles cited here- I encourage you to check them out!

https://pubmed.ncbi.nlm.nih.gov/28504066

https://pubmed.ncbi.nlm.nih.gov/37555313

https://pubmed.ncbi.nlm.nih.gov/39144037

February 2025