ACL Injuries in Young Women

By: Paul M. Saluan, MD • Posted on February 04, 2021

ACL Injuries in Young Women

What is an ACL Injury?

The anterior cruciate ligament (ACL) is one of the most important ligaments in the knee and acts to stabilize the knee during athletic activities. Most ACL injuries occur without any contact while landing from a jump, cutting, rapidly stopping, or changing directions.

Females have a 3-4 times increased rate of ACL tears compared to males at all ranges of activity from recreational to professional sports. The most common sports that young women tear their ACLs in are soccer, basketball, and volleyball. When the ACL tears, injury can also occur to different types of cartilage in the knee that can lead to increased risk of arthritis later in life.

Why do Females Have Higher Rates of ACL Tears Than Males?

There are many researched contributing factors that lead to young women having much higher rates of ACL tears than males. These include:

  • Differences in anatomy between females and males, including the dimensions of the ACL and the size of the notch that the ACL is attached in the knee.
  • The ways young women tend to land from jumping along with the ratio of muscle strength in their thighs can result in higher ACL tear rates.
  • Hormonal differences in young women can increase the risk of ACL injury.

What can a Woman do to Decrease her Risk of an ACL Injury?

Some of the factors that increase young women’s risk of ACL injury cannot be modified. However, the riskier pattern of landing from a jump and the thigh muscle strength can be adjusted to reduce the risk of an ACL injury.

“Jump training” is a program that teaches proper landing techniques and can work on strengthening the athlete’s hamstring muscles. These programs can be taught by physical therapists and athletic trainers and have shown promise in preventing ACL injury in young women.

What are the Best Treatments for ACL Tears?

ACL tears are best treated with surgery to stabilize the knee allowing for cutting, pivoting, and returning to sports participation. ACL surgery is done arthroscopically which means using small tools and a camera (scope) through incisions around the knee.

Directly repairing the ACL with sutures alone has been shown to have high re-tear rates, so ACL reconstruction is the current gold standard treatment. During surgery, the ACL is reconstructed using the patients own tissue taken from other tendons around the knee (autograft) or from cadaver tendon (allograft).

In young women, the gold standard preferred method is to take the patients own tissue (autograft) because there are significantly lower rates of failure and re-tearing of the ACL with the patient’s own tissue. ACL surgery is a same-day surgery where patients will not have to stay overnight in the hospital. Recovery to return to sports after surgery takes 8-12 months and involves physical therapy.

Be Strong, Be Healthy, Be in Charge!

-Paul M. Saluan, MD

Paul M. Saluan, MD, holds joint appointments in the Center for Sports Health and the Center for Pediatric Orthopaedic Surgery within the Orthopaedic and Rheumatologic Institute at Cleveland Clinic. He is the Director for Cleveland Clinic Sports Medicine Education and Community Outreach. Dr. Saluan specializes in pediatric and adolescent sports medicine and arthroscopic surgery. He is certified in orthopaedic surgery by the American Board of Orthopaedic Surgery, and holds a Subspecialty Certification in Sports Medicine. In addition, Dr. Saluan is the Director of the Orthopaedic Surgery Skills Lab and has developed a novel Arthroscopy Skills Lab Curriculum to teach residents and fellows. He is actively involved in a host of multi-center research covering the broad spectrum of sports injuries and management.


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