The female ACL: why is it more prone to injury?

Orthop Clin North Am. 2002 Oct;33(4):637-51. doi: 10.1016/s0030-5898(02)00028-7.


Multiple factors are responsible for ACL tears. The key factor in the gender discrepancy appears to be dynamic, not static, and proximal, not distal. The factors involved in evaluating the female ACL are multiple. However, it is the dynamic movement patterns ot hip and knee position with increased flexion and a coordinated proximal muscle firing pattern to keep the body in a safe landing position that are the most critical factors. An ACL injury at an early age is a life-changing event. We can very successfully reconstruct and rehabilitate an ACL, but we cannot stop there. We must now go into the prevention arena. In the United States there is tremendous variation in the exposure and acquisition of skills of physical activities in our youth. Today, children are often playing inside, using computers and watching television-missing out on the opportunity to learn safe movement patterns. Therefore, physical movement classes should occur very early in life, teaching children to land safely and in control, similar to the cry of "get down, stay down" routinely heard during youth soccer. Similarly, specific strength training programs can address landing as well as foot movements during cutting in basketball. Coaches should issue stern warnings when athletes demonstrate a high-risk movement patterns such as one-leg landings, out-of-control baseline landings, or straight-leg landings. The warnings may serve to keep the athlete from "touching the hot stove again" for fear of getting burned. No athlete feels she will be the one to get injured. Therefore, prospective analysis is likely to be received more warmly by the athletes if the program is presented with an emphasis on performance improvement rather than injury prevention. With increased participation in these programs, multiple-center analysis will have the power necessary to determine which factors significantly predispose athletes to ACL injury. The future for injury prevention is bright. We must rise to the challenge.

Publication types

  • Review

MeSH terms

  • Anterior Cruciate Ligament Injuries*
  • Athletic Injuries / epidemiology
  • Athletic Injuries / physiopathology
  • Basketball / injuries
  • Female
  • Gonadal Steroid Hormones / physiology
  • Humans
  • Knee Injuries / epidemiology*
  • Knee Injuries / physiopathology
  • Knee Injuries / prevention & control
  • Knee Joint / anatomy & histology
  • Male
  • Menstrual Cycle
  • Muscle, Skeletal / physiology
  • Pronation
  • Rotation
  • Rupture
  • Sex Characteristics*
  • Soccer / injuries


  • Gonadal Steroid Hormones