Which intrinsic risk factor contributes to ACL injuries in female athletes?

• A. Neuromuscular control deficits
• B. Greater knee valgus
• C. Q-angle
• D. Hormonal fluctuations

Answer: (C)

A larger Q-angle indicates a wider separation between the line of the thigh (hip-knee) and the line of the shin, reflecting the overall alignment of the knee relative to the hip and ankle. In many females, a greater Q-angle is common due to pelvis width, and this structural alignment tends to create more medial knee collapse (dynamic valgus) during activities like landing, jumping, or changing direction. That increased valgus load translates into higher strain on the ACL, making injuries more likely. Because the Q-angle is an inherent anatomical feature of the limb, it’s considered an intrinsic risk factor—an inherent predisposition built into the person’s structure, not something created by movement or environment.

Neuromuscular control deficits and knee valgus during activity are important contributors to injury risk, but they describe how the knee behaves during movement rather than a fixed anatomical trait. Hormonal fluctuations have been discussed as a factor in ligament laxity, but the most direct intrinsic factor among the options that explains why ACL injuries are more common in female athletes is the Q-angle.