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.




American Academy of Orthpaedic Surgeons Australian Orthopaedic Association   Royal Australian College of Surgeons    International Society of Arthoscopy, Knee Surgery & Orthpaedic Sports Medicine     Queensland Shoulder Society

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