Female Athletes and ACL Tears


This blog was written by Dr. Katie Surls. She discusses the specific anatomy of ACL sprains and tears, and why female athletes are more commonly impacted. She also gives useful tips to help athletes avoid this painful injury.


One of the most common injuries among athletes is an anterior cruciate ligament (ACL) sprain or tear.  This injury is seen most commonly in sports with dynamic explosive movements such as soccer, football, and basketball.  Female athletes are two to four times more prone to ACL injury than males.  Why is this the case and how do you help prevent risk of injury? Let’s dive in.

Knee Anatomy

The knee joint is one of the largest and most important joints in the body.  Stability for the knee is provided by the muscles surrounding the joint, which include the quadriceps, hamstrings, and calf muscles, as well as the ligaments within the joint capsule. These ligaments connect the thigh bone to the shin bone.

knee anatomy

Let’s break down the ACL acronym.  The “A” in ACL stands for anterior. Anterior means “in front.”  Cruciate, the “C”, means “cross shaped” and ligaments connect bone to bone. The “L” simply stands for ligament.

So, the ACL and PCL (posterior cruciate ligament) are both connective tissues that cross and provide internal knee support.  Alternatively, the medial and lateral collateral ligaments (MCL and LCL) provide support on each side of the knee.  The ACL is the most common ligament torn in the knee since it prevents the femur from shifting backwards on the shin bone.

There are two ways to sustain an ACL injury. The first is direct contact or force to the knee joint can cause the ligament to tear.  The second is a non-contact injury. This is caused by increased load and force of the quadricep muscle which forces the femur to shift backward resulting in tearing of the ACL ligament. You will see this most often when an athlete plants to cut and tries to explode out of the cut.  The athlete will feel a “pop” followed by pain and swelling.

Increased ACL Tears In Female Athletes

There are several factors that contribute to the increased risk of ACL tears among female athletes.  First is the relationship between your hip and knee anatomy.  Females have a larger and wider hip in comparison to males with a narrower and more compact hip. The thigh bone or femur connects from the hip socket to the knee and forms what we call the Q-angle (quadriceps femoris angle).  The greater the Q angle from the hip to the knee, the more force or load placed on the knee joint.

The second factor is imbalance between the quadricep muscles and hamstring/glute muscles.  Tightness and quadricep dominance paired with weakness in hamstring and glute muscles create more twisting and stress on the ACL ligament.

The last contributing factor is increased estrogen level which leads to increase ligament laxity.  Proper training and preventative exercises can drastically decrease the risk for ACL injuries.

Rehab Exercises For ACL

Incorporating a few rehab exercises into your warm-up routine or training can decrease risk for injury.  As mentioned above, the quadricep muscle can become too tight due to overuse or weakness in your hip.  A foam roller is a great tool to combat this tightness.  The foam roller is the toothbrush for your muscles. The more you roll, the cleaner the muscle.

Strength and stability are also important to maintain, especially in the hamstrings and glutes.  Weakness in these muscles places more stress on the knee and causes the quadricep muscles to become overactive.  So, the key to rehab are these two muscle groups.  Dr. Crisp demonstrates several exercises in the link below.

***Disclaimer: Always consult with your doctor before starting any exercise program. If you experience any numbness, tingling, or reproduction of your symptoms, please contact your doctor.

Knee pain can be the first indicator of an imbalance in these tissues and needs to be addressed quickly to decrease your risk for ACL injury as an athlete.  Our providers will take the time needed to pinpoint and treat the root cause of your pain, resolving injuries at the source. Schedule an appointment with an Airrosti provider today to help keep your knees, hips, and ACL healthy, stable, and strong.

If you prefer to find treatment from the comfort of your home, consider scheduling a remote telehealth appointment. With telehealth, we can deliver our expertise directly to you.

Give us a call at (800) 404-6050 to learn more.

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