Why Do Young Female Athletes Face Higher Risk for ACL Injuries

Anterior cruciate ligament (ACL) tears are one of the most common and serious injuries in young athletes and teenage girls, and young women are especially vulnerable, particularly those who play high-impact sports like soccer, basketball and volleyball.

Female athletes are up to eight times more likely than male athletes to experience an ACL tear, which often requires surgery and months of recovery.

ACL injuries can be physically and emotionally devastating for athletes eager to stay competitive. But with proper training, awareness and early intervention, many of these injuries can be prevented or treated to avoid long-term consequences.

To learn why young women are more vulnerable and how they can reduce their risk, the Cedars-Sinai Newsroomspoke with Michael Banffy, MD, chief of Sports Medicineat Cedars-Sinai Orthopaedics.

What is the ACL and what role does it play in the knee?

Banffy: The ACL-or anterior cruciate ligament-is one of four main ligaments in the knee. It crosses over inside the joint and helps control both the rotation and forward movement of the tibia (shinbone) relative to the femur (thighbone). It helps stabilize the knee and protects structures like the meniscus and cartilage during pivoting or cutting movements.

Why are ACL injuries more common in young female athletes?

Banffy: It's multifactorial. Anatomically, females tend to have a more "knock-kneed" alignment-called valgus-which can put more stress on the ACL when landing or changing direction. They also typically have less muscle mass around the knee compared with males, which limits the protective effect of the surrounding musculature. And we believe hormones, such as estrogen and progesterone, affect ligament laxity and may play a role, though we're still learning exactly how.

Adolescent females are particularly vulnerable, especially during or after puberty when hormone levels begin to fluctuate more significantly. Recent research-including studies from our own institution-suggests that high levels of estrogen during certain phases of the menstrual cycle may increase ACL injury risk.

Which sports carry the highest risk?

Banffy: Sports that involve jumping, cutting and pivoting-like soccer, basketball and volleyball-tend to have the highest rates of ACL injuries. These movements can put sudden, intense strain on the ligament, especially if athletes haven't developed proper landing techniques.

How can an athlete tell if they've torn their ACL?

Banffy: Often, it's obvious. Many athletes report hearing a "pop" and experience immediate swelling or instability. But not every tear is dramatic-some are more subtle, especially in non-contact injuries. A common symptom is a feeling of the knee "giving way," even if there isn't much swelling or bruising.

How is an ACL tear diagnosed and treated?

Banffy: Diagnosis starts with a clinical exam and is confirmed with imaging, particularly an MRI. For young, active individuals, surgery is strongly recommended to reconstruct the torn ligament-typically using a tendon graft from the same leg. While the patient may feel normal after a few weeks, full recovery and return to sport often takes nine to 12 months to allow the graft to mature.

Can anything be done to prevent ACL injuries in female athletes?

Banffy: Absolutely. ACL prevention programs-which include strength training, neuromuscular control drills and landing technique instruction-are critical. These programs are often built into team warmups and can significantly reduce injury rates when done consistently. For example, simple bodyweight exercises like squats and hamstring-strengthening movements help stabilize the knee, while jump training teaches athletes how to land safely and with control.

What advice do you have for girls eager to return to the field after surgery?

Banffy: Be patient. The ligament may feel fine after a few months, but the biology takes time. Pushing too soon can risk reinjury, which is heartbreaking for athletes. We use force plate testing to measure balance and strength between legs-once the injured leg is at least 85% as strong as the uninjured one, we can gradually reintroduce sport-specific training.

If you've already had one ACL injury, your risk of injuring the opposite knee is four times higher. That's why prevention training is so important-not just before injury, but especially afterward. And while reinjury can be discouraging, it's not the end. Revision surgeries are possible, and many athletes successfully return to sport with the right treatment and rehab.

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