Which injuries, and how much more
The clearest differences are in non-contact ACL injury, patellofemoral pain and bone stress injuries. Adolescent female athletes sustain non-contact ACL injuries at several times the rate of male peers in the same sports, and patellofemoral pain is consistently more common in girls.
By contrast, growth plate conditions such as Sever's disease and Osgood-Schlatter affect both sexes, though they tend to appear a year or two earlier in girls because puberty starts earlier.
The neuromuscular spurt boys get
During puberty, boys typically experience a large increase in muscle mass and force production alongside their growth in height. Girls grow in height and mass too, but without the same automatic increase in strength relative to body size.
The result is that many adolescent girls are asked to control a bigger, longer body with proportionally less force available. That shows up most clearly in landing and cutting, where control depends on being able to absorb load quickly.
Movement patterns under load
These are trainable. They are also the strongest identified risk factors, which is why neuromuscular training programmes are so effective in this group.
- Greater knee valgus, the knee collapsing inward, on landing and cutting.
- Landing more upright, with less hip and knee bend to absorb force.
- Quadriceps-dominant deceleration with relatively less hamstring and glute contribution.
- Reduced single-leg control, especially during rapid growth.
Anatomy and hormones
Structural factors - pelvis width, ligament properties, notch dimensions - contribute, and hormonal fluctuation across the menstrual cycle may influence tissue properties. But these are largely non-modifiable and explain only part of the difference.
Focusing on them can be counterproductive if it implies risk is fixed. The modifiable factors are strength, landing mechanics, load management and energy availability, and they carry most of the practical leverage.
Energy availability
Under-fuelling is more prevalent in adolescent female athletes and is associated with bone stress injuries, disrupted menstrual function and impaired recovery. Adequate total energy intake is a genuine injury prevention measure, not a separate nutrition topic.
What reduces the risk
- Structured neuromuscular warm-ups, performed two to three times a week.
- Progressive strength training year-round, particularly hamstrings, glutes and calves.
- Deliberate landing and deceleration training with feedback on knee position.
- Load monitoring across all teams, especially during growth.
- Adequate energy intake, sleep and iron status.