Anterior cruciate ligament (ACL) injuries are very common in women's soccer, with a significantly higher incidence compared to their male counterparts. This difference is attributed to multiple factors, such as anatomy or hormonal cycles.

"Female soccer players have a significantly higher risk of anterior cruciate ligament (ACL) injuries compared to males, with a risk between 2 and 8 times higher (average 2.2). In adolescent female players, the relative risk is 3.12 versus other sports. The incidence rate is 0.148 per 1000 athletic exposures, the highest among female school sports. In professional leagues, such as the Spanish and German leagues, between 9.6 and 11 ACL tears are reported per season, which is equivalent to an average of 0.7 injuries per team each season," says Dr. Carlos de José Reina, a specialist in traumatology and orthopedic surgery at the Hospiten Rambla University Hospital.

The prevalence of anterior cruciate ligament injuries in women's professional soccer players is significant and represents a considerable burden in terms of time lost due to injury, with an average of 292 days lost per injury. The majority of these injuries occur most often without direct contact (54% non-contact, 34% by indirect contact and 11% by direct contact) in a primarily dynamic valgus lower limb axis injury mechanism. "The most common injury mechanisms are rapid changes of direction and sudden decelerations, being more frequent during matches than in training. This suggests that the intensity of competitive play is a relevant risk factor, especially during the first half of the match. Moreover, goalkeepers have a lower propensity to suffer this type of injury compared to outfield players," assures the specialist in sports traumatology.

This higher risk of ACL injury in women is attributed to anatomical, hormonal and biomechanical factors, as well as to neuromuscular activation patterns.

Regarding biomechanical and anatomical factors, women have an increased internal rotation of the hip and a higher prevalence of dynamic knee valgus during activities such as changes of direction, landings and pivoting at the knee, which increases the load and torsional moments on the ACL, increasing the risk of rupture. Compared to men, among the main anatomical differences, the Q Angle and pelvic alignment are noteworthy. "Women present a wider Q Angle (formed by the quadriceps traction line and that of the patellar tendon) due to a wider pelvis. This characteristic may predispose to a greater knee valgus and, consequently, to a greater risk of anterior cruciate ligament injury. Another differential anatomic factor would be a narrower intercondylar width and greater joint laxity, which also contribute to the risk of ACL injury," says Dr. De José Reina.

Likewise, hormonal fluctuations that occur throughout the menstrual cycle may influence the laxity of the anterior cruciate ligament (ACL), increasing the risk of injury. Regarding neuromuscular factors, it should be noted that female soccer players tend to have a lower hamstring/quadriceps strength ratio, as well as less neuromuscular activation of the knee stabilizing muscles. These conditions may predispose them to anterior cruciate ligament (ACL) injuries.

In parallel, in terms of extrinsic factors, playing field conditions, such as artificial surfaces and dry weather, may also increase the risk of ACL injuries. Finally, situational factors must be taken into account. Most ACL injuries in women's soccer occur without direct contact, during high-intensity maneuvers such as pressing, changing direction or landing after a jump.

"Preventive interventions that have been shown to be effective in reducing the incidence of anterior cruciate ligament (ACL) tears in female soccer players include neuromuscular and biomechanics training programs. These interventions focus on improving muscle strength, proprioception, landing technique and trunk stability," says Dr. De José Reina, a member of the medical service of the Costa Adeje Tenerife Egatesa, a women's soccer team that plays in the first division.

"ACL injury prevention programs usually include a variety of key components that address different aspects of physical and neuromuscular performance. Among them are strengthening exercises, focusing on the hamstrings, glutes and core. Also, plyometric exercises are incorporated, which seek to improve power and optimize landing technique. In addition, proprioception and balance activities are included to improve joint stability and neuromuscular control. Finally, these programs teach proper landing and deceleration techniques to reduce the risk of injury," he concludes.

This article is an English translation generated with AI from the original Spanish content. While we review content for clarity, the information is provided for general informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional for diagnosis or treatment.