Knee pain is common across all age groups, but research consistently shows that women are at a higher risk of developing certain knee problems, particularly osteoarthritis. While lifestyle and activity levels do play a role, there are important anatomical, hormonal and biomechanical factors that also contribute.
Understanding why women are more vulnerable allows for earlier intervention, smarter prevention strategies and better long-term outcomes.
Knee osteoarthritis in women
Osteoarthritis is the most common form of arthritis. According to research, women are more likely than men to develop knee osteoarthritis, particularly after the age of 50, and they often experience more severe symptoms.
Several factors contribute to this. Women typically have wider pelvises, which affects the angle between the hip and knee, sometimes referred to as the Q angle. A larger Q angle can increase stress across the knee joint, particularly at the patellofemoral joint. Over time, this altered load distribution may contribute to cartilage wear.
Hormonal influences also play a role. Oestrogen is thought to have a protective effect on cartilage. As hormone levels decline around menopause, the protective effect may diminish, potentially accelerating joint degeneration.
Imaging studies show that cartilage loss appears to progress more rapidly in women. A comparative study found that women experienced a greater rate of cartilage loss at the knee compared with men over time. This faster degeneration may partly explain why women report higher rates of symptomatic knee arthritis.
ACL tears and the long-term consequences
Women are also more likely to sustain anterior cruciate ligament injuries, particularly in sports involving pivoting and jumping such as football, netball and skiing. Differences in neuromuscular control, landing mechanics and ligament laxity are thought to contribute to this increased risk.
The long-term implications are significant. A study of female football players found that more than half developed radiographic knee osteoarthritis within 12 years of an ACL injury.
An ACL tear doesn’t simply affect stability in the short term. It can alter joint biomechanics and increase the likelihood of secondary meniscal or cartilage damage. Even with reconstruction, the knee may remain at increased risk of developing osteoarthritis later in life. Early diagnosis, appropriate management and structured rehabilitation are therefore crucial to protecting the long-term health of the joints.
Patellofemoral pain and alignment issues
Another condition more commonly seen in women is patellofemoral pain syndrome, often referred to as anterior knee pain. This typically presents as discomfort around or behind the kneecap, particularly when climbing stairs, squatting or sitting for prolonged periods.
Biomechanics again play a central role. The combination of pelvic width, muscle strength patterns and dynamic knee alignment, can increase lateral forces on the patella. Weakness in the hip stabilisers and quadriceps may allow the kneecap to track slightly off-centre, leading to irritation of the joint surface.
While patellofemoral pain doesn’t always lead directly to osteoarthritis, persistent maltracking and abnormal loading can contribute to cartilage wear over time. Early physiotherapy focusing on strength, movement control, and load management, can reduce symptoms and improve long-term outcomes.
Protecting knee health in women
Although women face a higher risk of certain knee conditions, many of these issues are modifiable. Strength training that targets the quadriceps, hamstrings and gluteal muscles improves joint stability and reduces abnormal forces across the knee. Neuromuscular training programmes have been shown to reduce ACL injury rates in female athletes by improving landing mechanics and control.
Maintaining a healthy body weight also reduces stress on the knee joint, lowering the risk of osteoarthritis progression. For those who have sustained previous ligament injuries, regular follow-up and proactive rehabilitation remain important to monitor joint health.
If knee pain persists, early specialist assessment can help identify underlying biomechanical or structural factors. With tailored treatment and preventative strategies, many women can maintain active, pain-free lifestyles while reducing the long-term risk of joint degeneration.
If you are experiencing knee issues and want to get to the root of the problem, book an appointment with Mr Shah Punwar today.
