ACL and the Female Athlete

- Cameron Craig, Physiotherapist

The Anterior Cruciate Ligament (ACL) is a major component within the knee joint and is a common topic of conversation in the sporting population. While there is a risk for every athlete to injure their ACL, the risk for females are even higher.

Research has shown a couple reason as to why females are  at more risk than males. Some of the factors include:

  • Differences in skeletal structure
  • Increased laxity of the knee joint
  • Landing, cutting and pivoting biomechanics
  • Neuromuscular differences

An injury to your ACL can lead to quite drastic outcomes such as a major lack of function, an inability to complete work and daily task, surgery might be warranted (which can lead to a 12 month plus rehabilitation period) and a very likely chance of not returning to sport. The level of return to sport varies between individuals, sporting populations and studies. One study reported that 80% of patients post ACL repair returned to some form of sport, however only 65% returned to pre-injury level and 55% returned to competitive levels.


Prevention is a common word used when talking about trying to stop injuries from occurring, however the fact is sometimes you will get injured no matter your prevention programs. That’s why minimising your risk is the best you can do and there are strategies to minimise your chance of ACL injuries.

Whilst some of the reasons female athletes are at more of a risk then males cannot be changed, some definitely can. The biomechanics of landing, cutting and pivoting movements as well as neuromuscular deficits can be retrained and can typically be linked to strength issues. While there isn’t a one size fits all approach to risk management, the demands needed for athletes can be assessed and specific exercises given to ‘prevent’. Some group sports are becoming a lot more aware of the increased risk and are implementing programs into the group session and warmups to target any issues seen. The typically exercises would include quad and glute strength as well as balance and control of landing, change of direction, acceleration and deceleration.




Ardern, C.L., Taylor, N.F., Feller, J.A. and Webster, K.E., 2014. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med, 48(21), pp.1543-1552.

Smith, H.C., Vacek, P., Johnson, R.J., Slauterbeck, J.R., Hashemi, J., Shultz, S. and Beynnon, B.D., 2012. Risk factors for anterior cruciate ligament injury: a review of the literature—part 1: neuromuscular and anatomic risk. Sports health, 4(1), pp.69-78.

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