Harmon KG, et al. [6]

2000

Compilation of articles

Female increased predisposition to ACL ruptures

Intrinsic factors:

Ligamentous laxity

Hormonal influences (more ACL laxity at progesterone and estrogen peaks, increased laxity in pregnancy and in ovulatory phase)

Biomechanical alignment (more femoral anteversion, larger Q-Angle, increased external tibial torsion, more overpronation, an increased thigh-foot angle)

Extrinsic factors:

Conditioning, experience, skill, muscle strength and recruitment and hamstring activation.

Dugan SA [7]

2005

Compilation of articles

Female higher risk than men

Sex hormones and menstrual cycle (higher risk follicular and ovulatory phase)

Anatomic consideration (Q-Angle, joint laxity, …)

Dynamic neuromuscular imbalances (differences in landing and other movement strategies)

Neuromuscular patterns (same incidence in dominant and non-dominant knee, quadriceps-dominant pattern in females)

Fayad LM, et al. [8]

2008

63

33/30

-/-

(43)

Females 2 to 8 times higher risk of ACL tears

Anatomic consideration: Smaller females' cross-sectional area, smaller femoral intercondylar notch width in women, also females have a smaller ACL volume than males and differences in Q-Angle.

Park SK, et al. [9]

2009

26 healthy women (unknown age)

Greater laxity during ovulation

Reduction in knee stiffness during ovulation

Boguszewski DV, et al. [10]

2015

47

22/25

34.6/28.4

(31.5)

70% ACL ruptures by non-contact situations

Females 2 to 8 times higher risk of ACL injuries than male

Increased joint laxity

Reduced knee stiffness

Larruskain J, et al. [11]

2017

85

50/35

25/25

(25)

Contact injuries higher for men

For ACL ruptures five times more common in women

Severe injuries of knee and ankle ligament more frequent in women

2-3 times higher risk of ACL ruptures in women than men → differences in biomechanics and neuromuscular control

Schilaty ND, et al. [5]

2018

39

19/20

43.1/40.0

(41.55)

Female higher risk than men

Non-contact injury

Biomechanics changes

Neuromuscular control

Sex differences: kinematics, stiffness and recruitment strategies.