Researchers: women’s ACL injuries “growing area of concern”

“I don’t remember anything except just falling to the ground,” Australian lacrosse player Rebecca Lane says.

“People told me that I was screaming, I don’t remember that at all – I just remember rolling on the ground, not knowing what’s happening.”

Rebecca is an extraordinary athlete who’s experienced what a lot of sportswomen have: an anterior cruciate ligament injury, commonly known as an ACL tear.

But for her it didn’t happen just once or twice, but three times.

In 2011 Rebecca was 15 years old representing Victoria in the U18 National Lacrosse tournament, when she faced her first sporting heartbreak.

In the first two minutes of the game, after taking a shot a goal she tore her left ACL.

The standard recovery time for this type of injury is nine months to a year but Rebecca wouldn’t be on her feet again, fully, until 18 months later.

In 2015, playing for her local club Footscray, she planted her left foot to defend when her opponent ran into her.

She fell again, causing damage to the same spot in her knee.

“And I think I ended up getting a foul, don’t know how that happened,” she says.

At this point she was training for the U19 Australian women’s lacrosse team, so the timing was devastating.

After doing what she calls “hardcore rehab” for seven months, she was able to represent her team in Scotland, Edinburgh.

Soon after this Rebecca was on a full scholarship to St Joseph’s – a division one college in Philadelphia, USA.

In her final year, she only partially teared the same knee.

The surgeon had to take her patella tendon from her right knee to put in her left, making her recovery time 14 to 16 months.

“Technically I should have been in a wheelchair, but being in college and moving around a lot, I was on crutches instead,” she says.

Researchers say Rebecca’s unbelievable story aligns with the current attention being paid to the prevalence of ACL injuries in women’s sport.

Multiple studies confirm that female athletes have a significantly higher anterior cruciate ligament injury rate than males.

A lot of the research has concluded that women are two to four times more likely to tear their ACL than men.

Why are women more prone to tearing their ACL?

Anthea Clarke, a sport and exercise scientist at La Trobe university, says it’s very easy for people to say that women’s bodies are different to men as a reason for the greater risk.

“I think it’s a lot more detailed and nuanced than that, yes there’s some differences in our biomechanics around our knee and hip,” she says.

What Clarke is referring to is women having wider hips than men, which can affect the alignment of the knee.

This in turn can cause a “knock-kneed” inward movement which puts stress on the ACL during landing or turning.

Women’s knees are also more flexible than men which causes more hyperextension on the knee, straining surrounding muscles, tendons, and ligaments.

“But women also have less muscle mass that contributes to it,” Dr Clarke says.

“When we think about muscle mass, how we acquire muscle mass and what contributes there, you’ve got this whole sociocultural element to it.”

The menstrual cycle has also been a research focus but there isn’t sufficient evidence to prove if it affects the risk of ACL injuries in women.

Dr Clarke says it was thought, at one point, that during a cycle women have a bit more joint laxity but that’s not realistic.

She says the physical and bodily functions aspect of menstruation does play a part, but there are also other factors like how girls growing up don’t have as much support as boys do, lower quality coaches usually being aligned with girls sport, and girls not having access or encouragement to go to the gym to build strength.

All of this, Dr Clarke points out, can change the development of their movement profiles.


“Yes, maybe our knees and our hips are different, but if we’re not coached or taught how to run, fall, jump, land, all of that contributes to this increased risk in ACL – it’s not as simple as bone, muscle, strength, or women having weaker bodies than men,” she says.


The research finds that internal and external risk factors are all involved – those inherent to the athlete such as sex and genetic factors and external relating to the environment such as the weather conditions or if there are any potholes on the field.

“Then you’ve got modifiable and non-modifiable [factors] so these are really interesting and important ones that we want to consider – if we can identify what those modifiable factors are, then that’s going to help reduce that injury risk,” Dr Clarke says.

She emphasised that people should not be focused on the biomechanics and instead teaching women to build their strength, and provide the same support given to male athletes so that such injuries can be avoided.

“There is nothing stopping women from having strength,” she says.