A new study published in the British Journal of Sports Medicine, involving the University of Bath, questions the widely cited claim that women are 2-10 times more likely than men to sustain ACL (anterior cruciate ligament) injuries.

Led by researchers from the GenderSci Lab, the study argues that current methods for calculating ACL injury rates are biased. These methods fail to consider the gendered inequalities women face in sports, such as fewer training opportunities, smaller team sizes, and limited access to resources.

The authors argue these factors could artificially inflate women’s ACL injury rates, overstating the gender disparity. The findings urge a reassessment of injury metrics to ensure fairer and more accurate comparisons.

How are ACL injury rates calculated?

ACL injury rates are typically measured by dividing the number of injuries by the time athletes spend training or competing—known as “athlete-exposures” (AEs). However, this study identifies major flaws in this method, particularly for women’s sports. Women often spend more time competing in matches, where the risk of injury is higher, compared to training. Smaller team sizes in women’s sports further skew AE calculations, inflating injury rates when compared to men.

Dr Sheree Bekker from the University of Bath and founder of the Feminist Sport Lab said:

Accurately measuring ACL injury rates is crucial for developing strategies to prevent these serious injuries. If flawed methods are used, the true causes of injuries may be misunderstood and opportunities to address them could be missed. A universally precise ACL injury rate for women remains elusive, highlighting the need for further investigation. By refining these estimates and tackling the broader environmental, structural, and biomechanical factors contributing to ACL injuries in women, we can develop more targeted prevention strategies and create a fairer and safer sporting environment for all athletes.

Key findings:

The study highlights major issues with current ACL injury measurement methods:

  • Training vs. Competition: Failing to distinguish between training and match time inflates injury rates for women, who often spend proportionally more time competing

  • Team Sizes: Smaller team sizes in women’s sports skew comparisons with men’s teams

  • Broader Inequalities: Gendered factors like unequal compensation, substandard equipment, and external responsibilities (e.g caregiving) aren’t captured in current metrics but impact injury risk

Dr Sheree Bekker said:

This research exposes the biases deeply embedded in how we measure injury risks and highlights how the current framing of ACL injuries could discourage women from participating in sports, prompting decisions driven by fear rather than accurate risk assessments. By shifting the focus to nuanced, evidence-based data and targeted interventions, we can empower women to make informed choices, build confidence, and encourage greater participation. Addressing these biases is a critical step toward fostering safer, more equitable sporting environments for everyone.

Professor Sarah S. Richardson from Harvard University said:

Gender assumptions can influence scientific knowledge in many different ways. When gendered assumptions are built into scientific measures, sex difference findings may not be accurate. Recent claims about higher vulnerability of women athletes to ACL knee injury are a case in point.”

Ann Caroline Danielsen from Harvard T.H. Chan School of Public Health said:

We hope that this research will contribute to capturing patterns of ACL injury among women and men more accurately, and to identifying actionable avenues for addressing the socially-mediated drivers of ACL injuries among athletes.

Annika Gompers from Emory University Rollins School of Public Health said:

Athletes deserve solid statistics to understand the extent and drivers of disparities in ACL injury. Our work highlights that current research fails to account for biases in the data produced by gendered factors, which skews comparisons of injury rates between women and men. We call for more rigorous epidemiologic measurement of gender disparities going forward.