Specificity of Anterior Cruciate Ligament Injuries in Female Athletes: An Analysis of Biomechanical, Hormonal and Neuromuscular Factors in Injury Prevention

Background: Anterior cruciate ligament (ACL) injuries represent a major orthopedic challenge in sports medicine. Female athletes sustain these injuries at substantially higher rates than their male counterparts, necessitating a deeper investigation into sex-specific risk factors. Aim: This review offers a comprehensive analysis of the multifactorial etiology underlying the sex disparity in ACL injury rates. By integrating evidence from epidemiological studies, biomechanical simulations, and biochemical analyses, it aims to inform the development of more effective prevention strategies. Methodology: The investigation centers on three principal risk domains: anatomical factors (including the Q angle and osseous geometry), hormonal fluctuations during the menstrual cycle (with emphasis on estrogen's influence on collagen metabolism and ligament stiffness), and neuromuscular patterns (such as quadriceps dominance and altered muscle recruitment). Results: The efficacy of evidence-based prevention programs, including the PEP, Sportsmetrics, and FIFA 11+ protocols, is evaluated using meta-analytic data. Additionally, this review addresses the controversial clinical practice of prescribing hormonal contraceptives for injury prophylaxis, weighing the evidence for hormonal stabilization against the limited availability of high-certainty data on long-term musculoskeletal health. Conclusions: This report synthesizes prevention strategies and emphasizes the need to transition from universal protocols to sex-specific, individualized athletic care. Addressing the interplay between biological and mechanical factors is proposed as a means to reduce injury rates and enhance the athletic longevity of female athletes.