With the participation of women in athletics growing rapidly over the last two decades, a disturbing gender-specific pre-disposition has emerged regarding anterior cruciate ligament (ACL) injuries of the knee. Female athletes have a two- to eightfold higher incidence of ACL injury than their male counterparts. It is estimated that 38,000 women sustain ACL tears per year. The majority of ACL injuries in female athletes occur through noncontact mechanisms, most often during deceleration activities, such as landing from a jump or cutting. The risk factors for noncontact ACL injuries can be categorized as intrinsic (anatomic and hormonal) and extrinsic (environmental and biomechanical). This article will discuss these risk factors that are thought to contribute to the higher incidence of ACL injuries in women, the development of prevention strategies, and the outcomes of ACL reconstruction in women.