 Illustration by Tenzin Chosang By Veronica Ha Imagine you’re watching a women’s soccer game. A player cuts to the left, pivots on her right leg, and suddenly crumples to the ground. No contact. Just a sharp twist, a scream, and the all-too familiar sight of someone clutching their knees. If it feels like you’ve seen this scene play out a lot in women’s sports, that’s because you have. Female athletes are significantly more likely to tear their anterior cruciate ligament (ACL) than their male counterparts, with some studies estimating between 2 to 8 times more likely, depending on their sport [1]. The question is: why? Are women inherently more fragile? (spoiler: no). Is it bad luck? Or is something deeper, more scientific going on? The ACL is a key ligament that stabilizes the knees, running diagonally through the joint and preventing the tibia (shinbone) from sliding too far forward. It’s essential for movements like pivoting, cutting, and landing. When torn, it almost always requires surgery and months of rehabilitation. But when it comes to ACL injuries, the playing field is not equal. One key culprit is anatomy. Women typically have wider hips, which increases the angle at which the thigh bone meets the knee. Known as the Q-angle, this sharper alignment places more stress on the knee, especially during high-impact directional changes. Imagine a rope connecting two beams at an angle: the wider the angle, the more tension the rope endures. In the body, that tension falls on the ACL, as the femur and tibia are pulled in different directions.
Anatomy is only one part of the story, neuromuscular differences also affect how female athletes move. For example, many women land from jumps with their knees caving inward, a motion called valgus collapse that significantly increases ACL strain. This pattern often stems from imbalance in strength between the quadriceps, hamstrings, and gluteal muscles. Hormonal fluctuations add yet another layer towards the impact of ACL injuries in female athletes. During the menstrual cycle, particularly around ovulation, levels of estrogen and relaxin tend to rise, increasing ligament laxity. This makes ligaments loose and therefore less stable. This reduces joint stiffness and impairs neuromuscular coordination, the nervous system’s ability to control muscles smoothly, thereby raising the risk of injury [3]. Consequently, ACL injuries tend to spike during this phase when joint stability and muscle control are compromised, with hormonal changes also affecting the brain’s regulation of muscle activation, increasing the likelihood of poor joint alignment and delayed reflexes [2]. Here’s the kicker: for decades, most sports gear, whether cleats, braces, or training protocols, were designed for male athletes. Women’s versions were, quite literally, smaller and pinker, ignoring critical differences in foot shape, limb ratios, and biomechanics. The result? Poor fit, inadequate support, and increased injury risk. Ill-fitting cleats can disrupt gait (the way you walk) and landing mechanics, adding to the anatomical and hormonal factors that put female athletes at risk. Research shows female feet differ significantly from male feet, with narrower heels, wider forefeet, and higher arches, features most cleats fail to accommodate [2][4]. This long-overlooked discrepancy has led to instability and a higher chance of injury, but only recently have brands begun designing equipment tailored specifically for women. To make matters worse, traditional training programs have largely been developed with male athletes in mind, failing to adequately address these vulnerabilities specific to women. IDA Sports, a female-centered athletic brand, is leading the way by designing performance cleats specifically for women, using 3D scans of over 700 women’s feet to create anatomically accurate shoe lasts [5]. Their cleats feature a wider toe box, narrower heel cup, and enhanced arch support to improve fit, reduce foot slippage, and promote proper lower-body alignment, all of which are crucial for protecting the knee. By collaborating with biomechanists and podiatrists, IDA has engineered cleats with shorter, conical studs and optimized pressure distribution to balance traction and safe rotational movement, minimizing the torsional stress that often causes non-contact ACL injuries during pivots and decelerations [6]. The higher ACL tear rate in women reflects real biological differences and decades of overlooked female-specific needs in training, equipment, and research. However, growing awareness is prompting menstrual cycle-informed training and the development of women-focused gear like IDA’s, alongside advancing research aimed at injury prevention. Perhaps the ACL isn’t out to get women, the disparity in injury rates isn’t a mystery or curse, but rather the result of real, biological factors and long-standing gaps in design and training. With smarter science, better equipment, and systems that truly consider female athletes, gender-based ACL injuries rates can evolve into a thing of the past. References [1] Arendt, E., & Dick, R. (1995). Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer. The American Journal of Sports Medicine, 23(6), 694–701. https://doi.org/10.1177/036354659502300611 [2] Belanger, L., Burt, D., Callaghan, J., Clifton, S., & Gleberzon, B. J. (2013). Anterior Cruciate Ligament Laxity Related to the Menstrual Cycle: An Updated Systematic Review of the Literature. The Journal of the Canadian Chiropractic Association, 57(1), 76–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581006/ [3] Herzberg, S. D., Motu’apuaka, M. L., Lambert, W., Fu, R., Brady, J., & Guise, J.-M. (2017). The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine, 5(7), 232596711771878. https://doi.org/10.1177/2325967117718781 [4] Prempeh, M., & Pennington, C. G. (2025). Deconstructing Soccer Footwear: An Anatomical Review with Implications for Female Athlete-Specific Design. Universal Journal of Sport Sciences, 5(1), 24–30. https://doi.org/10.31586/ujss.2025.6130 [5] Why do you need women’s specific soccer cleats? (2022, September 1). Idasports.com. https://www.idasports.com/blogs/expert-advice/why-do-you-need-women-s-specific-soccer-cleats
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