Female sports participation has increased over the last decades. As a result, more sports injuries are seen in female athletes. Females tear their anterior cruciate ligament (ACL) at a higher rate than males. Females have unique features that make them more susceptible to sustain an ACL injury. Neuromuscular, anatomical, biomechanical, genetic, and environmental risk factors have been identified as reasons for the increased risk. Prevention programs have been implemented. Compliance to those programs is critical to perceive a protective effect. After ACL reconstruction, females have worse postoperative outcomes and lower return to sports than males. Graft selection and postoperative rehabilitation are critical to minimize knee laxity, retear rates, and maximize return to sports. Renewed interest in lateral extra-articular procedures may decrease knee laxity and help improve postoperative outcomes. Females experience more anxiety and depression symptoms than males. As a result, they may experience lower postoperative outcomes. Screening could help identify patients at risk. Future research is paramount to expand on prevention programs and improve postoperative outcomes, ultimately leading to a higher return to sports.