ACL injuries have become one of the most concerning trends in youth sports, particularly among female athletes. Orthopedic surgeons and sports medicine physicians consistently see higher rates of anterior cruciate ligament tears in girls and young women participating in sports like soccer, basketball, and volleyball. In fact, female athletes are two to eight times more likely to sustain an ACL injury than their male counterparts in similar sports.
While anatomical and hormonal differences play a role, emerging research suggests another important factor: movement patterns that develop early in childhood.
Early Movement Patterns Matter
A recent study examining youth athletic development found that poor fundamental movement skills in childhood may be associated with higher ACL injury risk later in adolescence. These foundational skills—things like jumping, landing, balance, and directional changes—form the building blocks of athletic movement.
When these mechanics are not developed properly at a young age, athletes may unknowingly adopt movement patterns that place excessive stress on the knee joint.
This is particularly relevant for female athletes. Researchers have found that girls are more likely to demonstrate certain biomechanical patterns that increase ACL strain, including inward knee collapse during landing, reduced hip and core control, and differences in neuromuscular activation around the knee. These movement patterns can amplify stress on the ACL during cutting, pivoting, and sudden deceleration—common movements in many popular youth sports.
Why the Risk Is Higher for Girls
Studies evaluating youth movement mechanics have shown that athletes who struggle with basic coordination tasks—such as controlled jumping or stable single-leg landings—often display the same patterns associated with ACL injuries. These include excessive knee valgus (where the knee collapses inward), poor trunk stability, and delayed muscle activation around the hips.
From a sports medicine perspective, the encouraging news is that many of these risk factors are modifiable.
Prevention Programs Can Make a Difference
Neuromuscular training programs designed to improve strength, balance, and landing mechanics have been shown to reduce ACL injury rates by as much as 50 percent in some youth sports populations. These programs typically include exercises that emphasize proper jumping and landing technique, single-leg stability, hip and core strengthening, and agility drills.
The key, however, is starting early.
Teaching Movement Skills Early
Just as young athletes are taught sport-specific skills like dribbling, shooting, or skating, they should also learn how to move safely and efficiently. Developing strong movement fundamentals during childhood helps athletes build better mechanics as their bodies grow and sports demands increase.
Parents and coaches can support this process by encouraging participation in a variety of activities rather than specializing too early. Multi-sport participation helps build coordination, balance, and neuromuscular control. Structured warm-up programs that incorporate balance and landing drills can also reinforce safe movement patterns before practices and games.
A Shift in Prevention
For clinicians, this research reinforces an important shift in thinking. Preventing ACL injuries in female athletes may not begin in high school or even middle school—it may begin much earlier, when the basic foundations of movement are first developing.
As youth sports continue to grow in intensity and competitiveness, teaching young female athletes how to move well may be one of the most effective strategies we have to reduce serious knee injuries later in life.
Reference
DiStefano, L. J., et al. (2024). Fundamental movement skill competency and biomechanical risk factors for ACL injury in youth athletes. Journal of Sports Medicine and Physical Fitness.
