Why Females Tend to Have Higher ACL Injury Risk than Males in Soccer and Basketball

Jul 11, 2017

Soccer and basketball are not limited to males. Nowadays, you see females being active and engaged in these sports as well. But like males, females are not an exception to injury. In fact, their injury rate, particularly ACL injury, is higher than that of men.

During the game, female soccer players tend to have ACL injury rates 2-5 times higher than males. In basketball, they are 2-8 times more likely to sustain ACL tear than males.

What are the Common Causes of ACL Injury in Female Athletes?

Common factors that cause ACL injury to female athletes include:

  •    Shoe-surface interface
  •    Bone dimensions
  •    Muscle strength
  •    Knee joint laxity
  •    Proprioception
  •    Balance
  •    Neuromuscular activation patterns
  •    Muscle fatigue

A study done by Rozzi et al explained why female athletes are more likely to sustain an ACL injury than males. The researchers examined and compared joint laxity, joint proprioception, balance, peak torque production time, and muscle activity of both male and female soccer and basketball players during functional tasks.

Thirty-four collegiate-level athletes, composed of 17 males and 17 females, were included in the study. None of the participants had a previous ligament injury to either knee joint, and all of them had a functionally stable ankle joint. In addition, none of them reported suffering from any disorders that impair their sensation or balance.

The participants were randomly grouped for the data collection on variables including knee joint laxity, knee joint proprioception, single-legged balance ability, the amount of time required to generate peak torque of the knee, and reactive muscle activity in response to landing.

Why Female Athletes are More Susceptible to ACL Injury

The results of the study showed that female athletes have more knee joint laxity than male athletes. They also demonstrated a longer time to detect knee joint motion and have better single-legged balance. Interestingly, females showed greater EMG peak amplitude and area of the lateral hamstring when landing from a jump.

However, female athletes tend to have compensatory muscle-activation patterns. They were able to stabilise their knees through excessive joint laxity and proprioceptive deficits. Because they are able to rely on compensatory patterns, they may potentially perform injury-causing movements, such as deceleration manoeuvres or landing without injuring their ACL.

Interrupting the compensatory muscle-stabilising activity can cause a joint that is unable to resist forces and may lead to ligament injuries. In female athletes, ligament injury may be led by a lack of preactivated motor activity as they have less joint proprioception and they do not have much reflex capability for joint protection, or they may be unable to generate muscle force rapidly enough to absorb joint forces and protect the ligament.

It appears that the excessive joint laxity of female athletes may contribute to weak joint proprioception. This makes them less sensitive to potentially damaging factors and may increase their injury risk.

The study may theoretically help female athletes in stabilising their joints. However, its effectiveness in the long run and in response to different joint conditions and forces are not yet known.

Seeing a Perth Physiotherapist is a must to prevent ACL injury. Book an appointment at Happy Physio on 92727359 today!



Rozzi SL, Lephart SM, Gear WS, Fu FH. Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players. American Journal of Sports Medicine. 1999; 27: 312-9