Why Do Females Have More ACL Tears?

Based on statistics, women have more knee injuries... but why? Let's talk anatomy.

Do women really have more knee injuries?

Unfortunately, they do. In fact, in some sports (such as skiing and soccer) women are 4-5 times as likely to tear their Anterior Cruciate Ligament (ACL) than their male counterparts."

I've been fortunate enough to be the head physician for the U.S. Women's Alpine ski team for over twenty years.

Due to this, I've been in a unique position to observe some of the factors that contribute to the fact that our female athletes have more knee injuries then their male counterparts During that time, I've seen my share of knee injuries to these world-class female athletes, and fixed a few of those knees personally.

Which Sports Have the Most Knee Injuries in Females?

Women's volleyball, women's soccer, women's basketball, and even recreational skiing are all sports in which female participants have a much higher chance of tearing the ACL.

And it doesn't just effect world class athletes-- unfortunately, it applies to everybody.

Why are females more susceptible to knee injuries?

There are many reasons that contribute the higher risk. Let's talk about the anatomical reasons here today.

Women's ACL Tears - The Anatomical Factors

Women Are More Valgus Than Men

Women are inherently more "Valgus" than men. What does valgus mean? Essentially, it means that women naturally stand a bit more "knock-kneed" than males.

How does this affect the knee? Being built more knock-kneed puts a bit more stress on the joint (see the video below for a visual demonstration.)

So to sum it up, being more knock-kneed leads to the knee ligament "always being on stretch", which is a major anatomical factor that lends itself to more ACL tears.

Women Are More Loose-Jointed than Men

You may not have heard the term "hyper-lax", but it's quite important in this context.

Basically, hyper-lax means "loose-jointed".

So what does that mean for us in the context of injuries?

It means that elbows hyper-extend, shoulders are easier to dislocate, and even kneecaps can pop out of joint with less trauma.

And in my practice, I end up seeing knees that hyper-extend. In fact, some women are able to hyperextend up to 25% from normal. And that much stress upon the ligament puts it at more risk.

Anatomical Differences Result In More Knee Injuries In Females

So, in conclusion, being born hyperlax and a little more knock-kneed are the majaor anatomical factors that lead to more knee injuries in female athletes.