Female athletes are far more likely than males to suffer serious knee injuries
Female athletes are three times more likely to suffer from anterior cruciate ligament (ACL) ruptures, one of the most common knee injuries, compared to male athletes.
The ACL (anterior cruciate ligament) is one of the four major ligaments of the knee. It connects the front of the tibia (shinbone) with the back of the femur (thighbone). It helps provide stability to the knee joint. Patients with torn ACLs often experience their knee “giving out.”
Most ACL tears do not occur from player-to-player contact. The most common causes of noncontact ACL injury include: change of direction or cutting maneuvers combined with sudden stopping, landing awkwardly from a jump, or pivoting with the knee nearly fully extended when the foot is planted on the ground. 
Dr. Pietro Tonino, Loyola University Medical Center orthopedic surgeon, and other orthopedic surgeons are seeing a significant number of knee injuries in female athletes, ranging from middle school to the pros. Tonino is a sports medicine specialist who has performed thousands of knee surgeries. 
Doctors aren’t certain why female athletes are more prone to ACL injuries. One reason may be related to how they jump, Tonino said. Due to the shape of the female pelvis, females tend to land from a jump with their knees locked. This puts added pressure on the knee. Females also tend to be more knock-kneed — with knees close together and the ankles far apart.
Minor ACL tears can be treated by nonsurgical means. But significant ACL tears require surgery. An orthopedic surgeon removes a tendon from the patient’s knee and uses it to replace the torn ligament.
“Unfortunately, a reconstructed knee will never be as good as the God-given knee,” Tonino said. “So we should be doing all we can to prevent these injuries in the first place.”
But Dr. Tonino suggests that doing preseason conditioning could prevent many of these injuries and using proper landing techniques after jumping.
“All female athletes, starting in adolescence, should learn appropriate training techniques,” according to Karen Sutton, MD, assistant professor, Yale University Department of Orthopaedics and Rehabilitation. “This includes the appropriate way to land from a jump, increasing the strength of muscles that could have a protective affect on the ACL—core, gluteal, quadriceps and hamstring muscles, as well as working on the body’s reaction to change of direction and change of speed.” 
I have my own theories on why ACL injuries are more prominent in female athletes including the female athlete triad* but there is one aspect in particular that I want to focus on given the context of this article. My theory simply stated is that young female athletes “train to play but they don’t play to train.” In other words they play their sport but don’t take part in any off-field conditioning to prepare for the demands of that sport. And if they do any off-field conditioning it is entirely inappropriate and likely a modified version of a bodybuilding workout or a men’s strength and conditioning program.
I had a meeting a few weeks ago with a group of coaches/PE teachers and an athletic trainer from a local high school. The discussion turned to the topic of female strength and conditioning. This past winter I worked with the soccer program at a local high school. My emphasis with their programming was to reduce their risk of injury by focusing on body control and equipping them with a superior set of brakes (ability to reduce force and control momentum). The athletic trainer told me that there was only one significant knee injury (ACL) all season across the three teams (Freshmen, JV and Varsity) and it was the result of a girl being clipped from behind by an opponent. This injury rate was a significant reduction from previous seasons.
According to the trainer when I first started working with the girls they were skeptical because they weren’t “sore” and “exhausted” after their workouts. Eventually they bought in only after they started to feel the benefits of having more control because they were stronger and moved more efficiently. In America we have this “old-school” mentality when it comes to sports training that it has to be super intense and induce extreme sweating and/or vomiting. That “feel the burn” bodybuilding mentality will make athletes tired but it won’t necessarily make them better and more durable.
My bottom line when working with athletes is did they stay healthy? If so then it gave them the opportunity to improve their skill and performance through their ability to consistently practice and play their sport. Athletes should not be trained to make them a champion in the weight room. The training programs ultimate appraisal is does it help them stay on the field/court and do they play better? If the answer is yes then the program has accomplished what it was designed to do.
It can be tempting to throw advanced training protocols at kids to impress parents, boosters and coaches but the vast majority of kids aren’t prepared for it. Kids need to master the basics when it comes to off-field/court/ice training. And just when you think they have it figured out… A growth spurt slams their body into a state of confusion or they may have just experienced their first relationship issue and can’t sleep at night. This is probably not the ideal time to hit them with a “butt-kicker” of workout. Less is often more effective (quality over quantity) for young athletes and if we can equip them with a superior set of brakes (physically, mentally, and emotionally) they will have far more control over where they are ultimately headed.