The ACL Crisis: Why Female Athletes Are Frequently Facing One of Sport’s Most Feared Injuries

December 8, 2025 The Gown Queen's University Belfast 527 Views 0 Comments 10 min read

By Grace Allen

As shown in the graph above, girls consistently experience significantly higher ACL injury rates than boys across a 15-year period – a clear indicator that this is not an isolated issue, but a persistent trend overlooked for decades.

The terrifying injury no one prepared female athletes for.

Firstly, what exactly is an ACL and what makes the injury so frightening? Your Anterior Cruciate Ligament, known by most as an ACL, is a strong tissue band inside the knee that links the thigh bone to the shin bone. Its key role is to provide essential support to the knee, stabilising the joint during movement – especially when changing direction, making sudden stops, jumping or pivoting. An ACL injury occurs when the ligament is sprained or entirely torn and can be recognised through severe pain or swelling, a ‘pop’ sound occurring at the time of the accident, instability in the knee and difficulty bearing weight on the leg. The only way to repair the ligament is unfortunately through tear repair surgery, and the recovery period can take anywhere from up to 12 months and beyond. However, this is completely athlete dependent ^[1]! Now that you understand the mechanics of the ACL, how to spot the injury and the repair/recovery period, you can grasp how detrimental this kind of injury can be to an athlete’s career.

A shocking statistic shows that female athletes are 2 to 8 times more likely to suffer from an ACL injury than their male counterparts ^[2]. This isn’t just narrowed down to a measly couple of sports, but rather it occurs very frequently across football, volleyball, basketball, skiing, lacrosse and gymnastics to name a few.

Leah Williamson: The Lighthouse of the ACL Crisis

Leah Williamson OBE, athlete, footballer, Arsenal player, Lioness with 64 senior caps to her name and ACL victim ^[3]. Leah’s ACL tear became a symbol of something far bigger than her. The timing was completely heartbreaking for many, and due to her high-profile status was picked up in a flurry by the mainstream media. Back in 2023, she was the captain of England – the reigning 2022 European Champions. Her injury meant she was forced to miss the 2023 World Cup, leaving a captaincy-sized hole in her squad and England without their peak defensive line-up. The key to this immense coverage was that her tear in particular occurred during a major epidemic of ACL injuries in women’s football, unsurprisingly sounding alarm bells across the sport.

Who in the Female Football World is Being Affected?

2022 – The First Few Fallen

Alexia Putellas (Spain/Barcelona) – ACL rupture, July 2022
Marie-Antoinette Katoto (France/PSG) – ACL rupture, July 2022
Simone Magill (Northern Ireland) – ACL rupture, July 2022
Catarina Macario (USA/Lyon) – ACL rupture, June 2022

The Arsenal Cluster (2022–2023) Four ACL tears in six months:

Beth Mead – November 2022
Vivianne Miedema – December 2022
Leah Williamson – April 2023
Laura Wienroither – May 2023

Williamson became the “lighthouse,” drawing global attention to the scale of the issue across the women’s game.

2023–2024 – The Domino Effect

Delphine Cascarino (France/Lyon) – May 2023
Sam Kerr (Australia/Chelsea) – January 2024
Mia Fishel (USA/Chelsea) – February 2024

In total, between 2022 and 2024, women’s football saw 11 major ACL ruptures among top international players. 8 took place in an extraordinary eleven-month window, evident in the ‘Arsenal Cluster’ that heavily exposed the epidemic. This is a pattern far too significant occurring at such a high level to dismiss as a mere coincidence. Ironically enough, that’s exactly what happened with female athletes’ ACL injuries up to this point: ignored, dismissed, and brushed under the carpet. Andy Williams, UK Consultant Knee Surgeon, actually spoke out with a thought-provoking statement regarding the lack of extensive research,

“There’s a lot of data on men’s sports but women’s data is really weak. When I’ve done my research to follow up what happened to players after injury, it’s all on the internet for men. You can find what happened to a 16-year-old at a certain club, how long did they last, when did they get back? But the women just vanish.”

What biological differences increase ACL risk for women?

Firstly, females have a wider pelvis. This contributes to a larger Q-angle, also known as a quadriceps angle. The angle is created when the pull of the quadriceps meets the line of the patellar tendon. In turn, this affects knee alignment and can often result in a valgus positioned, widely recognised as ‘knocked knees’. Furthermore, this places an increased amount of stress on the ACL, particularly during dynamic activities such as sports. As a result, the risk of injury in female athletes is heightened. Additionally, women are recognised as having, on average, both smaller and thinner ligaments than men. This means that they are less stiff and can fail at lower load levels compared to men. As well as this, women and men have differentiating muscle activation; women are more quad-dominant, and men engage the hamstrings more. This inadvertently acts as a protective mechanism that reduces the load on the ACL, actively preventing excessive strain or rupture of the ACL. Many sports openly ignore these red flags and have done so for years. Training programmes have historically been designed around the male body.

Women then use the same programme, train like men with female mechanics unaccounted for, increasing injury rates. Boys also tend to access strength training earlier, which helps them develop stronger connective tissue from a younger age, while girls often miss this crucial phase of strength and conditioning and enter sport more vulnerable to heavy loading. Hawaiian collegiate volleyball athlete, Sienna DeCambra’s widely publicised knee injury is a clear example of how one uncontrolled landing, combined with limited neuromuscular preparation, can result in catastrophic ACL failure. As women’s sport has become more professional, the pace, physicality, and match demands have increased dramatically. However, the medical support, funding, and strength and conditioning provision have not kept up to pace. Women are now competing at the same intensity as elite male athletes, but without the medical, conditioning, and recovery systems that protect men, leaving them more exposed to injury. This mismatch leaves female athletes carrying greater loads with fewer resources, heightening their risk of serious injury. In essence, female athletes are being asked to perform in systems that were never designed for their bodies, leaving them disproportionately exposed to preventable ACL injuries.

Hormones

Hormones, especially Oestrogen, affect ligament stability. It makes ligaments less stiff by altering the tissue structure – this is heightened particularly during the ovulation phase of the menstrual cycle. Progesterone and Relaxin can counteract this as they increase laxity in the ligaments; these hormones usually only exist at high levels in the female body during the luteal phase of the menstrual cycle. Additionally, hormonal fluctuations like pregnancy and contraceptives have significant impacts as well, with Oestrogen decreasing collagen and, in turn, stiffness. Sport rarely adjusts training around this, which is one of the main factors as to why women are at a higher risk of suffering an ACL injury. Beyond biology, the environment female athletes compete in plays an equally crucial role.

Equipment built for women

The industry has to start accommodating its female athletes, and in football, what better way to start than with boots. Women had no other option than to wear male-designed boots, designed for the male foot’s shape, their weight distribution and their overall biomechanics with excessive traction that anchored the foot to the ground while the remainder of the body continued to move during dynamic manoeuvres. Of course, this led to a higher injury risk for women.

Lack of research leads to injury; it’s as simple as that. To combat this in 2016, Adidas launched their very first football boots ‘Metallic Shimmer Pack’ made specifically for female athletes. The noticeable differences were the bespoke fit, tailored to the physiology and shape of the female foot, unique stud configuration, featuring shorter and smaller studs with unique positioning to provide better traction performance. In 2023, Nike introduced the new ‘Phantom Luna’ boot. The boot’s design is ‘female-first’, leveraging extensive data and feedback from top female players to optimise each and every aspect of their biomechanics. It featured an asym fit (asymmetrical ankle cuff) and a new upper design to provide a snugger fit around the ankle leading to increased stability. Additionally, it offers increased mid-foot adjustability to accommodate different arch height and a cyclone 360 circular stud pattern near the toes to allow better rotational traction and quick changes of direction. This, in particular, was made to target non-contact ACL injuries. In 2025, Adidas have released to ‘F50Sparkfusion’, overall building on the ‘Phantom Luna’ with enhanced design, improved lockdown (collar) and cushioning for the female boot.

Accommodation is key

Women’s sport is evolving faster than the systems designed to protect the athletes at its centre. The ACL crisis is not an unfortunate coincidence, nor an inevitable part of the game – it is the predictable outcome of decades of research gaps, male-centred training models, and equipment that surprisingly failed to consider half the population. We only hear of the high-profile athletes suffering from these injuries; yet there are countless unsupported cases. All in all, until women are supported with the same science, resources and respect as men, preventable injuries will keep ending careers before they’ve had the chance to peak. The solution isn’t mysterious: invest properly, design intentionally, and finally build sport around the bodies of the women who play it. Women’s bodies aren’t the problem – the system is.

References:

IMAGE: https://projectplay.org/news/2023/11/22/analysis –serious –knee –injury –among –teen athletes –grows –26