The increasing popularity and profile of professional female sports has recently shifted attention towards the high incidence of anterior cruciate ligament (ACL) injuries amongst elite female athletes. Media attention has focused on the disparities between males and females sustaining ACL injuries, particularly amongst professional football players. The success of major sporting competitions, such as the FIFA Women’s World Cup, has led to increased exposure and participation in sports by women and girls. As such, the increasing prevalence of female ACL injuries is predicted to continue increasing and accelerate in the near future. Female athletes are more likely to suffer from an ACL injury than their male counterparts but are less likely to undergo ACL reconstruction (ACLR). However, they have poorer outcomes when they do undergo surgery. In this chapter, we review the key epidemiological and etiological differences between male and female ACL injuries. We also discuss the anatomical, biomechanical, neuromuscular, hormonal, and sociocultural factors that are thought to predispose females to ACL injury. Finally, we discuss important considerations when performing ACLR in females and review outcomes and injury prevention strategies.