For athletes, the game isn’t just something they play—it’s a core part of who they are. An athlete’s worst fear is a season ending injury or anything that comes between them and playing the sport they love. For many female athletes, that fear has a name: a torn anterior cruciate ligament, or ACL—an injury so common and devastating, it’s starting to be referred to as an “epidemic” in women’s sports.
The ACL is a crucial band of tissue that connects the shinbone to the thigh bone, helping to stabilize the knee by controlling forward movement and rotation. But for female athletes, this vital ligament is also incredibly vulnerable. Due to a combination of anatomical, hormonal and biomechanical factors, one in every 29 female athletes will suffer an ACL tear, and they’re up to six times more likely to experience this injury than their male counterparts.
Several anatomical differences put female athletes at greater risk. For one, women typically have a wider pelvis than men, which causes the knees to angle inward, placing added stress on the ACL. Additionally, women tend to have smaller intercondylar notches—the grooves at the back of the femur where key ligaments, including the ACL, are housed. These narrower notches give the ligaments less room to move, increasing the likelihood that they could be pinched or torn during intense physical activity.
Aside from the physical disadvantages that women face with ACL tears, they also experience a hormonal disadvantage. During the menstrual cycle, rising estrogen levels can make ligaments more stretchy and flexible—precisely the opposite of what you want for a stable ACL. This increased laxity can put women at greater risk for injury.
ACL tears are particularly common in sports that demand quick stops, sharp pivots and sudden changes in direction—such as basketball and soccer. What may surprise many is that nearly 70% of these injuries are non-contact, meaning they often occur without any collision at all. The fact that the majority of ACL tears are non-contact actually makes the injury scarier, as it can happen at any time and anywhere, no matter the environment you are in.
Emma Struck, a third-year women’s soccer player at Case Western Reserve University, has faced the challenge of ACL injuries twice in her career, tearing the ligament in both knees in back-to-back setbacks.
“The second time around was honestly more difficult,” Struck said. “Obviously both times it was extremely frustrating, discouraging, and upsetting. However, the first time around I was honestly just depressed and upset at first. But the second time, I was harder on myself, wondering what more I could have done to prevent this.”
While the tear itself is the initial injury, the real challenge lies in the recovery. A complete ACL tear typically requires surgery followed by a six to nine month rehabilitation process. This is where the injury has its greatest impact on athletes. For many, especially college athletes, their sport structures their entire life. Classes, social events and personal time all revolve around practices and team commitments. So when, in just a matter of seconds, everything you’ve built your identity around—your athleticism, fitness and work ethic—comes to an abrupt stop, it can take a heavy toll on the mind.
“I have always been proud to be defined as a soccer player because I have always known I was good,” Struck said. “Now, I struggle being proud and confident being defined as a soccer player because I don’t want to be known as the girl who’s always injured. It’s almost like a little bit of imposter syndrome, like my credibility and identity as a soccer player has been taken away from me.”
Tearing an ACL typically means missing the rest of the season, but the effects can go even deeper. During recovery, the injured leg is essentially out of commission, forcing the healthy leg to take on all the work. This overcompensation can create imbalance and strain, increasing the risk of injury. Like in Struck’s case, when an athlete finally recovers and returns to play, it’s not uncommon for the previously healthy leg to give out—resulting in a tear of the other ACL.
“My college career has definitely not panned out the way I had expected or hoped for and coming to terms with that has been extremely difficult,” Struck said. “My now changed and complicated relationship with soccer has forced me to question if I should continue playing or if it is just never going to happen for me again no matter how hard I work.”
The numbers surrounding soccer and ACL injuries are truly staggering—nearly half of all ACL tears in the UK are linked to the sport. In the 2023 Women’s World Cup alone, between 25 and 30 professional players were sidelined due to an ACL tear. Yet, despite these alarming statistics, only about 6% of sports injury research is focused on women. This lack of research and initiative leaves little hope for meaningful progress in prevention and protection, making it even harder for female athletes to access the support and strategies they need to stay healthy.
“Even on the highest professional level, it feels like this injury is becoming extremely common despite growing efforts and discussions to prevent ACL tears,” Struck said. “I don’t know a single soccer team who does not have a member who has torn their ACL, so I honestly find it extremely frustrating that more programs don’t prioritize injury prevention programs despite the growing conversations.”
Although women face physical, hormonal and biological disadvantages, research shows that implementing prevention techniques—such as thorough warm-ups and cooldowns, strengthening the hamstrings, quadriceps, core and improving landing techniques and balance before and after practice could reduce ACL injuries by up to 73%, representing a significant improvement for female athletes.
“There is so much research out there regarding diets, strength training, mobility exercises, technologies, recovery practices, etc. aimed at preventing ACL injuries,” Struck said. “I absolutely think if this aspect of the game became more prioritized by coaches and programs we would see a decrease in the number of injuries.”
Although ACL injuries are widely acknowledged as an ”epidemic” among female athletes, they continue to be met with insufficient attention and action. Reducing the frequency of these season- and career-ending injuries—and the emotional and mental strain that comes with them—requires meaningful change starting at the high school level and continuing through to the professional ranks.
“I think today more than ever, people are becoming more educated on ACL tears and injury prevention because of the insanely large number of people who have unfortunately experienced this injury,” Struck said. “While some ACL injuries are more unavoidable, like a contact injury or a genetic factor, there is no reason that programs shouldn’t implement more recovery, and strength training programs aimed at preventing this prevalent injury.”