Understanding Sex-Based Differences in Anterior Cruciate Ligament Injury Risk and Management

» Anterior cruciate ligament (ACL) tears are one of the most common severe injuries in sports medicine, with notable differences in incidence and outcomes between male and female athletes.» While anatomical, biomechanical, and hormonal sex-specific factors such as quadriceps angle, posterior tibial slope, and cyclic hormonal variation have been extensively evaluated, the influence of psychological and societal factors, including fear of reinjury, access to training, and disparities in access to care, remains less well understood.» This review aims to provide a comprehensive overview of intrinsic (anatomic, biomechanical, and hormonal) and extrinsic (psychological, social, and environmental) factors contributing to sex-based differences in ACL injury risk. In doing so, we seek to highlight both the breadth of current understanding and the relative lack of research addressing external, sex-based influences on injury incidence and recovery.» Recognizing sex-based differences in ACL injury risk, treatment, and recovery should guide the development of individualized prevention and rehabilitation strategies to optimize outcomes for all athletes.