The ACL Knee Injury Epidemic in Women's and Girl's Soccer - 2023

The increasing incidence of Anterior Cruciate Ligament (ACL) knee injuries in women’s and girl's soccer as compared to their male counterparts is alarming and of great concern. More than 60 female professional soccer players have suffered ACL tears during the past 18 months in the run up to the 2023 World Cup in Australia and New Zealand, including 3 top U.S. women's national team players - Caterina Macario, Christen Press, and Tierna Davidson. Additionally, top national team goal scorer Mallory Swanson recently suffered a serious torn patellar tendon of the left knee requiring surgery, and national team mainstay Tobin Heath recently underwent an undisclosed "routine" knee surgery. These increasing injuries raise serious questions about how we need to better prevent them and support the female body in sport.

Tearing the ACL can be quite devastating, with a traditional recovery time of up to a year or more. ACL tears are more commonly non-contact injuries caused by a sudden change in direction or deceleration, as well as landing after jumping. Complete ACL tears almost always require surgery, which involves grafting a tendon from the athlete and using it to create a new ACL ligament. Of note is that ACL reconstructive surgery peak incidence is in girls 10 to 19 years of age.

Although there are multiple and different circumstances that have been proposed for the increasing incidence of ACL injuries at the elite professional level when compared to the younger amateur levels, there are some well-studied factors that can predispose all levels of female soccer players to ACL injuries. Those factors are as follows:

• A wider pelvis that leads to an increased "Q" angle of the femur, which places more stress on the knee.

• Muscle imbalances leading to "quad" dominance and/or medial (valgus) knee collapse.

• Much more naturally occurring of the hormone estrogen, which may cause increased laxity of tendons and ligaments.

• Increasing utilization of outdoor artificial grass fields and the use of improper cleats on those fields.

While many of the above factors are being better addressed at the elite and professional levels, younger club and recreational players, their coaches and parents, tend to have limited information about these.

It’s time to act now and address the factors that are leading to increased risk of ACL and other knee injuries, as well as for the implementation of reforms that include specific programs to mitigate the likelihood of such injuries.

Please visit our home page for more detailed information and researched prevention strategies that are easily implemented.

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