ACL injuries plague female soccer players more often than male players

“Well, kid,” one teammate said, “welcome to the club.”

Angeli would make it back onto the field, playing professional soccer in the top American leagues for five years. But she also would join the dreaded three-letter club twice more in her career.

Studies show female athletes are two to eight times as likely as male athletes to tear an ACL, one of the bands of tissue that connect the femur and tibia at the knee. Since 2021, at least 87 players from eight of the world’s top women’s soccer leagues have torn their ACLs. Some of the sport’s biggest stars — such as U.S. attacker Catarina Macario, Dutch star Vivianne Miedema and the English duo of Beth Mead and Leah Williamson — will miss the World Cup because of this injury.

This recent wave is not a statistical anomaly but further proof of an ongoing issue that has no simple solution. Addressing it, many in the sport say, requires a zoomed-out approach that begins at soccer’s lowest levels and peels back all the layers of a gendered problem, from the physiological to the environmental.

In a moment of global growth for women’s sports, the ACL crisis strikes at the heart of a broader challenge. How can the infrastructure of women’s sports not simply replicate what exists for men’s sports but be optimized for female athletes? At the top levels of women’s soccer, players argue, such resources have not yet been provided.

“Players are expected to be professional footballers. There’s an increase in matches, then there’s an increase in new competitions. But on the flip side of that, the professional standards to meet these professional obligations are just not in place,” said Alex Culvin, the head of women’s soccer strategy and research at FIFPro, the global players union.

“For a multi-factorial issue, I think there needs to be a multi-factorial solution.”

In the late 1990s, after studies began to show discrepancies in ACL injury rates between men and women across a range of sports, doctors and researchers searched for patterns.

At first glance, biology offered some insight. In women, the intercondylar notch, the area in the femur where the ACL sits, is narrower; additionally, women’s pelvises are wider, creating a higher angle between the hips and knees that can put greater stress on the quadriceps and the ACL. Female athletes tend to land flat-footed with knees inward on jumps and have more strength in the quads rather than the…