Knee injuries occur commonly in sports, limiting field and practice time and performance level. Although injury etiology relates primarily to sports specific activity, female athletes are at higher risk of knee injury than their male counterparts in jumping and cutting sports. Particular pain syndromes such as anterior knee pain and injuries such as noncontact anterior cruciate ligament (ACL) injuries occur at a higher rate in female than male athletes at a similar level of competition. Anterior cruciate ligament injuries can be season or career ending, at times requiring costly surgery and rehabilitation. Beyond real-time pain and functional limitations, previous injury is implicated in knee osteoarthritis occurring later in life. Although anatomical parameters differ between and within the sexes, it is not likely this is the single reason for knee injury rate disparities. Clinicians and researchers have also studied the role of sex hormones and dynamic neuromuscular imbalances in female compared with male athletes in hopes of finding the causes for the increased rate of ACL injury. Understanding gender differences in knee injuries will lead to more effective prevention strategies for women athletes who currently suffer thousands of ACL tears annually. To meet the goal in sports medicine of safely returning an athlete to her sport, our evaluation, assessment, treatments and prevention strategies must reflect not only our knowledge of the structure and innervations of the knee but neuromuscular control in multiple planes and with multiple forces while at play.