SHE- Strong Healthy Educated.

The Anterior Cruciate Ligament (ACL) is a key stabilizer in the knee that connects the femur (thigh bone) to the tibia (shin bone). Its primary scientific role is to prevent anterior tibial translation and provide rotational stability during the high-speed pivoting and cutting common in soccer (Boden et al., 2010). 

In simpler terms, you can think of the ACL as the "seatbelt" of the knee. Just as a seatbelt keeps a passenger from flying forward during a sudden stop, the ACL keeps the leg bones properly aligned when an athlete lands or changes direction. If the forces during a game exceed what the ligament can handle, it can overstretch or tear. This injury often leads to knee instability and a long road to recovery.

Research shows that female soccer players are between 2 to 8 times more likely to suffer an ACL injury than their male counterparts (Momaya, 2024). This disparity is not caused by a single factor but rather a "perfect storm" of biological and environmental elements.

The "Triple Threat" of ACL Risk

• Anatomy: A wider pelvis creates a sharper "Q-angle" at the knee, often leading to knee valgus (inward collapse) during pivots (Hewett et al., 2005). Additionally, a narrower femoral notch—the space where the ACL lives—can cause the ligament to "pinch"  (Mulcahey, 2024).
• Hormones: The ACL contains receptors for estrogen and relaxin. During specific phases of the menstrual cycle, increased hormonal levels can cause ligaments to become more "lax" temporarily decreasing the knee’s natural structural stability (Lefevre et al., 2013; Banffy, 2025).
• Movement (Neuromuscular): Many female athletes are "quad-dominant," relying on the front of the leg rather than the glutes and hamstrings for stability. Landing with "stiff" or straight knees forces the ACL to absorb impact that should be handled by the muscles (Myer et al., 2010; Sterett, 2025).

• Financial Cost: $15,000–$26,000+ per injury, with complex cases exceeding $50,000 (CareCredit, 2023).
• Recovery Time: 9–12 months of intensive rehab; returning early increases re-injury risk by 7x (JOSPT, 2025).
• Return to Play: Only 62–69% of female athletes return to their pre-injury performance levels (Figueroa et al., 2024).
• Mental Health: Many face "kinesiophobia" (fear of movement) and a loss of athletic identity (Paterno et al., 2024).
• Re-injury Risk: 15–25% of female athletes suffer a second ACL tear after returning (WifiTalents, 2025).
• Long-term Health: 30–50% develop knee osteoarthritis within 10–15 years, regardless of surgery (MJA, 2024).

At SHE Plays Strong, we offer a PT and soccer assessments designed specifically for female soccer players.  We focus on understanding the mechanics of movement and how to reduce the risk of ACL injuries.  Athletes will learn valuable skills to enhance their performance while prioritizing their safety.  Join us to become a more informed athlete.

Check out our free resource library with evidence-based research on preventing ACL injuries, sign up to learn more about an evaluation, explore our programs, and follow us on social media for the latest research and simple exercises you can do at home.