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Taking the case of anterior cruciate ligament (ACL) injuries, I explore how the gender differences and inequalities that fundamentally shape many sporting environments may contribute to injury in women athletes. I look to Australian Rules football (Aussie Rules)\u2014a male\u2010dominated, high\u2010contact, highly skilled running game and Australia's largest commercial sport\u2014where, following the launch of a women's professional league in 2017, a marked gender disparity in ACL injury has been reported. Rather than attribute this reported disparity to essential biological differences between women and men, I consider how gendered practices and disparities may accumulate across the life course of athletes with consequences for the embodied experiences of women and girls. Building on the concept of structural sexism as a key determinant of health, I document gender\u2010related differences and inequalities at the early childhood, youth, and elite levels of Aussie Rules football. 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