Female athletes are three times more likely than men to suffer anterior cruciate ligament (ACL) ruptures, one of the most common knee injuries.   Studies have found that pre-season and ongoing neuromuscular training programs aimed specifically at improving knee stability when jumping, landing or pivoting can significantly decrease ACL injury risk among girls and women. 

The anatomical differences between the male and female knee may contribute to higher injury rates, and should be taken into consideration during reconstructive surgery and sports training, according to a review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

The ACL is one of the four main ligaments within the knee that connect the femur (upper leg bone) to the tibia (lower leg bone).  
Unique anatomical features of female athletes such as a larger quadriceps angle ("Q angle")—the angle at which the femur meets the tibia—may cause a greater pull of the knee muscles during physical activity, and contribute to more ACL injuries among females.

"As female athletes have increased their participation in sports, many studies have shown the vulnerability of female athletes to ACL ruptures," said Karen Sutton, MD, assistant professor at Yale University and lead author of the review article. "This devastating injury has a long recovery period and a slow return to sport. Thus, research has been done focusing on why women are more vulnerable to ACL injuries and how to prevent them."

Anatomical differences in the female knee should be taken into consideration during ACL reconstruction, said Sutton. Females are more likely than males to have a smaller, A-shaped intercondylar notch (the deep groove between the rounded ends of the femur bone), making ACL reconstruction more challenging, and possibly requiring altered surgical techniques.

"All female athletes, starting in adolescence, should learn appropriate training techniques," said Sutton. "This includes the appropriate way to land from a jump, increasing the strength of muscles that could have a protective affect on the ACL—core, gluteal, quadriceps and hamstring muscles, as well as working on the body's reaction to change of direction and change of speed."