“Anatomical, Biomechanical, and Biochemical Factors Contributing to the Higher Incidence of ACL Injuries in Female Athletes Versus Male Athletes"

Abstract

Anterior cruciate ligament (ACL) injuries are prevalent among athletes, especially in sports involving rapid deceleration, pivoting, or jumping, with female athletes being disproportionately affected. This study aimed to assess the biomechanical and biochemical differences between male and female athletes, with a focus on ACL injury susceptibility. A total of 40 participants (20 males and 20 females) were recruited, and biomechanical tasks simulating athletic movements were performed using robotic knee simulators. Significant sex-based differences were observed in ACL strain and knee joint compressive forces during lateral cutting, pivoting, and jumping tasks. Females exhibited significantly higher ACL strain during cutting (5.3% vs. 3.8%) and pivoting tasks (8.2% vs. 6.1%), as well as higher compressive forces during jumping (1200 N vs. 1050 N). Biochemically, estrogen and progesterone levels were significantly higher in females, while testosterone levels were significantly higher in males (p < 0.001). No significant differences were observed in inflammatory markers or collagen turnover. These findings highlight that anatomical, biomechanical, and hormonal differences contribute to the increased ACL injury risk in female athletes, emphasizing the need for targeted prevention strategies.