Latest update on ACL rupture: differences between males and females

Key findings of a recent study from the American Academy of Orthopaedic Surgeons (AAOS) highlight the following differences between males and females:

  • The rate of ACL rupture is three times higher in female athletes than in male athletes.
  • Several factors may influence this result and predispose females to ACL injury, including:
    • increased quadriceps angle
    • increased posterior tibial slope
    • smaller intercondylar notch width
    • smaller ACL cross sectional area.
    • Although self-reported clinical outcomes are worse in females in the first two years after surgery, after this time period, studies show the outcomes are the same between the sexes.
    • Following ACL reconstruction, female athletes are more likely than male athletes to rupture the contra-lateral ACL; however the rate of re-rupture of a reconstructed knee is equal in both sexes.
    • Neuromuscular intervention protocols have been shown to reduce the rate of injury in female athletes.

The study also outlines:

Components of an Ideal Anterior Cruciate Ligament Injury Prevention Protocol
  • 10 min, 3 times/wk for approximately 8 wk
  • Preseason implementation for neuromuscular adaptation
  • Perform as a warm-up to avoid neuromuscular fatigue
  • Maintenance recommended to avoid deconditioning, which can occur at 2 to 8 wk
  • Must include neuromuscular and proprioceptive training, plyometrics, agility drills, functional balance, and core strengthening
  • Low cost and easy to implement
  • Identify at-risk players who need more intensive intervention (eg, drop vertical test)
  • Encourage compliance (eg, varied workouts, correlate training with improved sport/muscular performance, risk awareness education/training)

For further information, please refer to Sutton KM, Bullock JM. Anterior Cruciate Ligament Rupture: Differences Between Males and Females. The Journal of the AAOS, January 2013 Vol 21, No 1 pgs 41-50 available at

You may also find the following YouTube video of a drop vertical jump test a useful reference: This test has been established as an effective method to evaluate neuromuscular control and simulate motions and moments that place athletes at risk for ACL injuries.

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