Female-Specific Injury and Performance Science: The ACL “Epidemic” in Women’s Football and Basketball—A Narrative Review

Anterior cruciate ligament (ACL) injuries continue to disproportionately affect female athletes, particularly in pivot-heavy sports such as soccer and basketball. Despite increasing awareness, incidence rates remain significantly higher in women than in men. Advances in motion analysis have pinpointed key injury-prone scenarios, especially noncontact pivoting, pressing duels, and deceleration under reactive pressure, where poor neuromuscular control often plays a central role. Emerging evidence highlights sex-specific biomechanical risk factors, including increased dynamic knee valgus, greater internal hip rotation, and distinct landing mechanics, which are observed in female athletes. Contributing elements may also include anatomical differences, hormonal fluctuations during the follicular phase of the menstrual cycle, and interactions between footwear and surface traction. Preventive efforts are increasingly centered on personalized neuromuscular training programs to improve strength, proprioception, and postural control. Concurrently, there is growing interest in redesigning footwear specifically for the female form and in leveraging wearable technologies and AI platforms to track movement patterns in real time. However, implementation outside elite sports environments faces substantial barriers in cost, feasibility, and compliance. Custom shoe redesigns and advanced wearables are often resource-intensive and lack scalability for grassroots or community-level programs. Additionally, many AI-based systems require high-quality input data, regular calibration, and user training, which may not be realistic in school or amateur settings where budgets and staffing are limited. Ethical and equity considerations must also be taken into account. Athlete monitoring tools raise concerns regarding privacy, data ownership, and informed consent, particularly when used with youth or amateur populations. Furthermore, much of the existing research and innovation remains concentrated within elite women’s sports, risking a widening gap in access and benefit for nonelite, underserved, or developing athletic communities. Ensuring inclusive study designs and equitable funding allocation is critical to closing this divide. Ultimately, tackling the multifactorial contributors to ACL injury in female athletes requires integrated, context-sensitive solutions that account for both biological and sociostructural realities. Collaboration between clinicians, researchers, coaches, and policymakers will be vital to ensure that advances in prevention are both scientifically grounded and widely accessible.