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ACL Woes for Women

Updated: Aug 2, 2023

With the FIFA Women’s World Cup underway in New Zealand and Australia, this article in The New York Times jumped out at us.


It’s about knees. Specifically, female knees. More specifically, about the high rate of injuries to the anterior cruciate ligament (ACL) among female soccer players.


It’s a big problem.


And experts—anatomists, fitness trainers, shoe manufacturers, and the players—are still trying to figure it out.


It’s a problem, of course, because tearing your ACL could lead to nine or more months on the sidelines.


The New York Times’ piece calls it an “epidemic.” Among the fallen this year are a top U.S. forward (Catarina Macario) and two stars from the team from England (Leah Williamson and Beth Mead). On and on. This year, 60 players in Europe’s five major leagues had torn their ACLs. There is so much fear of tearing the ligament, the Times noted, that the worry has triggered a “psychological contagion.”


The players want it figured out, of course.


And, guess what?

Again, women are getting the short shrift. Soccer injuries among men have been studied for two decades. But the women’s side of analysis has only been running for five years. Is that one of the reasons the risk of injury for women is considered two to three times greater than it is for men?


But, you think, aren’t all knees the same? Female knees, male knees—what’s the difference?


Well, some studies have suggested that the female ACL is smaller. And there are differences in the hips, the pelvis, and the “engineering” of the foot.





Oh, and hormones too. Hormonal fluctuations, the article notes, may make players more susceptible to injury.


Let’s take a quick detour to point out:


  • Knees are the most complicated joint in the body, according to The Orthopedic Clinic. We could see an argument over this, given the shoulder’s range of motion!

  • Knees rely on 10 muscles to function—the four muscles in the quadriceps plus the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis and the group of the muscles in the hamstring (semitendinosus, semimembranosus, and biceps femoris.)

  • Hip abductors, glute muscles, and calf muscles also work together to stabilize the knee.

  • Babies are born without kneecaps—there is only cartilage where there soon will be bone (between ages two and six). Birthing mothers are likely very appreciative of this fact.

  • It’s estimated that about 100,000 ACL reconstruction surgeries are performed every year.


Back to our soccer players, women are playing more games and the intensity of the games has increased as well. Games are faster and more competitive. On top of that, women don’t have the resources that the men receive. As a result, their travel comforts are few and their medical teams aren’t as large. Also, their fields they play on may not be the pristine, highly-manicured pitches that the men are used to.


The extensive New York Times article highlights a woman who is manufacturing custom-made soccer cleats for women that take into account the female’s narrower heels, wider toe boxes and higher arches.


We think it must be tough for the female athletes to compete at a high level knowing this could affect them on the very next run down the field or during the next high-impact tackle. And yes, some female soccer players have walked away from the sport after tearing three ACLs.


So cheer on your favorite team in the 2023 edition of the Women’s Cup and stop to think about how much depends on those high-functioning knees and one key ligament inside.

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