Anterior cruciate ligament (ACL) tears are one of the most common injuries in soccer. In fact, studies have shown that female soccer players are 4-5 times more likely to suffer an ACL tear than their male counterparts. So, what makes them so susceptible to this type of injury?

In this blog post, we will explore the causes of ACL injuries in female soccer players and what can be done to prevent them. We hope that this information will help keep you safe on the field!

The Nature of The Game

The ACL is one of the four major ligaments in the knee that provides stability and helps with side-to-side movement. A torn ACL is a fairly common injury, especially in soccer, and can range from a partial tear to a complete rupture.  

One reason for this is the fact that soccer is inherently hard on the knee joint. The typical high-speed and rotational movements that are common in soccer can put added stress on the ACL. These include:

• Stop and start movements

• Sudden changes in direction

• Jumping and landing awkwardly

• Player-to-player contact 

It makes sense that soccer comes with a higher risk due to the game itself, but why are females, in particular, at a higher risk? It comes down to a combination of factors. 

Anatomical Differences

One reason female soccer players are more prone to ACL tears than male players is anatomical differences.

• Flexible joints - Women are more likely to be loose-jointed or hyper lax, meaning they can bend their joints beyond a normal range of motion. This greater flexibility makes the ACL more likely to be stretched… and torn. In fact, loose-jointed athletes are 4-5 times more likely to suffer an ACL tear.   

• Wider pelvis - Women generally have a wider pelvis than men, which causes the knees to angle inward more (knock-kneed). This puts more force on the ACL when the knee twists, making it more susceptible to injury. 

• Smaller intercondylar notch and ACL -  The ACL sits within the intercondylar notch and connects the femur and the shin bone. A small notch means a smaller ACL, making it more prone to injury. 

Physical and Technique Differences

While the anatomical differences play a role in ACL tear risk, there are two additional factors at play:

1. Jumping Technique

• Women tend to land with their knees in a straight, locked position, which applies greater pressure to the ACL.

• Women’s knees tend to buckle inward more upon landing (due to being more knock-kneed)

• Women are also more likely to land flat-footed instead of on the balls of their feet. This causes the knee to absorb the impact rather than the calf muscles.

2. Muscular Imbalance

Hamstring muscles play a significant role in protecting the ACL from injury. Females' hamstring muscles are often weak compared to their quadriceps. The knee compensates for this imbalance by placing additional stress on the ACL.   

Staying in the Game

While there are some risk factors that female athletes can't change, there are ways to reduce their risk of the dreaded ACL tear.

1. Retrain how you land.  As mentioned above, women tend to land on straighter knees. Instead, practice landing with your knees in a flexed position so that your muscles are absorbing the landing — not your ligaments. As your knees bend, ensure they are pointing towards your toes; don't let your knees "buckle" inwards towards each other.

2. Strengthen your hamstrings. Weaker hamstrings and gluteal muscles result in a muscular imbalance that can cause your knees to overcompensate. Building strength in both muscle groups will help offload some of the stress on your ACL.

3. Know if you are loose-jointed. Use the Beighton score below to measure your joint hypermobility.

To test for loose-jointedness, give yourself one point for each of the following:

1. You can place your hands flat on the ground without bending your knees

2. You can bend your knees backward beyond 10 degrees (2 points if you can do so on both knees)

3. You can bend your thumb back so that it touches the front of your forearm (2 points if you can do so on both thumbs)

4. You can bend your pinky back further than 90 degrees (2 points if you can do so on both pinkies)

5. You can bend your elbow backward more than 10 degrees (2 points if you can do so on both elbows)

The maximum possible score is nine points. If you score 7 out of 9 points, you are loose-jointed.

Contact the Leading Female ACL Injury Specialist 

Contact Dr. Sterett and his team today if you have questions about preventing ACL injuries or if you have been diagnosed with an ACL tear. With over 20 years of experience treating top female athletes and local residents alike, Dr. Sterett will work with you to get you back to performing at the highest levels of sport.

Schedule your appointment today by calling (970) 476-7220 or submitting a request using Team Sterett's online contact form. Telehealth appointments are also available!