Damage to the anterior cruciate ligaments (ACL) is among the most common injuries faced by athletes of every level. And female athletes experience this injury at an exponentially higher rate than males. Research shows female basketball and soccer players suffered respectively from 3.5 and 2.8 times more ACL injuries than male athletes.
This is due to a variety of factors, including hormonal, anatomic, and neuromuscular differences between the two sexes. A female typically has less muscle mass in their legs, along with generally more range of movement in their knee joints. And they have different shaped hips than men, putting their legs on the ground at a slightly different angle.
Here’s what you need to know about ACL injury and recovery in women and girls.
Why Are Females Athletes More Likely to Have an ACL Injury?
Humans are not born anatomically equal, nor do we grow the same over our lifetimes. Generally, the female pelvis is wider than a male’s to accommodate childbirth, and it narrows as she ages. By the end of puberty, a female’s pelvis is an average of 25% wider than a male’s. However, a 70-year-old woman’s pelvis is 8% narrower than a middle-aged woman.
This means a girl going through puberty is at a higher risk of an ACL tear because of that transformation alone. And they have smaller ACL ligaments, although it’s not necessarily known whether larger ligaments are stronger.
Females also have different techniques in pivoting, jumping, etc due to differences in core stability. And because of traditional gender roles, it wasn’t until recent generations that women were given the same training and knowledge needed to perform at a professional athletic level.
Sports are already among the biggest causes of ACL tears. It’s less likely to happen when navigating daily life, but athletic competition, especially on a professional level, puts you at a much higher risk for bodily injury. That’s why it’s important to practice a proactive approach.
How to Prevent ACL Injury
Women can often have stronger quadriceps than hamstrings, and they may require a different workout routine to ensure full leg strength and stability. Specific strength training programs that target these knee-supporting muscles can be helpful in preventing an ACL tear or ACL retear, which is a risk as well.
Even if repaired, the risk of a retear is also greater in women because of the same reasons outlined above. Muscle balance, core strength, and coordination are key factors to work on during athletic training. Many athletic trainers offer ACL injury prevention courses these days that can be very helpful as well.
If you do injure your ACL, you’ll need to determine whether surgery is needed.
Is ACL Surgery Necessary?
Torn ACLs can be either partial or complete, and only a complete ACL tear requires surgery. A partial tear can be rehabilitated without it in much less time, but it’s also the less common of the two ACL injuries.
ACL reconstruction surgery involves using a substitute tendon graft taken from the patellar, hamstring, or quadriceps tendons. It can be an autograft (from your own body) or an allograft taken from a medical cadaver. In those cases, you may also get an Achilles, semitendinosus, gracilis, or posterior tibialis tendon graft.
If athletics are just a hobby, some lifestyle changes may be necessary, but surgery may not be needed. But professional athletes, soldiers, or anybody else in a strenuous physical career will probably want the surgical option for the best chances of rehabilitation. However, you should be aware that not everybody recovers.
As mentioned above, a torn ACL can end your career, and this naturally causes depression, anxiety, and even rage. For some people, sports can be the entire identity that you dedicated your time, energy, and passion to your whole life. I know this because I’m one of them, and learning to pivot on my feet was nothing compared to the difficulty of learning to pivot in my life.
A torn ACL is one of the most common career-ending injuries experienced in professional sports. It can happen even before you ever go pro and derail your career options in career, high school, or younger. And it doesn’t typically happen alone – there’s a cornucopia of the knee and leg-related injuries that can happen concurrently with a torn ACL.
On its own, recovery time after an ACL surgery can take up to a year, although some people can recover within six months or less. It all depends on whether you take a holistic approach that encompasses all aspects of recovery, including mental and physical.
Even after surgery though, your ACL ligament never fully heals. The grafts simply reinforce the area with a new ligament that can be just as susceptible (or even more so) than the original one. And you may have done deeper damage to your knee and leg in the process. It’s possible that you may never compete on a professional level ever again.
This can be a hard adjustment, and it’s not easy to move forward when you lack direction.
Recovering from a torn ACL is both a physical and mental process. The injury itself can cause a shift in your career and life trajectory, and this takes an adjustment period. Many medical professionals will focus on physical recoveries, like relearning how to walk, turn, jog, jump, and simply move around your daily life.
Beyond that, you may also need help adjusting to other aspects of your life. When you’ve been born and bred to train and compete, it’s not easy “taking it easy” at home and on the sidelines. A warrior’s spirit never dies.
I had my own bouts with depression and trauma-related to an ACL injury and know that recovery takes a team effort. It is ok to not be ok, and you are not alone. Check out the rest of my blog, and my book (“Torn” about my personal journey to recovery from a torn ACL), or just reach out to me directly if you need some advice.