greg . 2025-06-30 12:19:36

ACL injuries in female soccer: A complex issue that continues to plague the sport

Leah Williamson was on top of the world in early 2023, playing the best soccer of her career for Arsenal and England and featured in advertisements ahead of the 2023 Female World Cup, when a torn anterior cruciate ligament forced her to a screeching halt.

The 28-year-old was one of almost 30 stars that missed that World Cup due to ACL injuries.

She is among numerous stars whose knee injuries have amplified the conversation around ACL tears, which have caused turmoil in the female fixture since of the massive toll they take on stars and teams.

While Williamson made a full recovery and is back to lead England at the European Tournament that kicks off on Tuesday in Switzerland, the injury remains a hot topic, with Spain's Teresa Abelleira, Ramona Bachmann of Switzerland and England's Ella Morris among stars out of the Euros with ACL tears.

Sophie Ingle was named to Wales' squad regardless the fact she has never played since she tore hers in September.

"ACL injuries have existed as long as female soccer has existed," Alex Culvin, the Head of Strategy and Research for Female Soccer at global stars union FIFPRO, told Reuters.

"It's really important that we prioritise ACL injury.

It's a holistic injury and affects stars' careers in a holistic way.

"Never sole do they miss a minimum nine months, in a career of 10 years you're twice, three times as likely to do another ACL injury.

And later you've got to think over the commercial opportunities and the career opportunities that stars defeat across this injury.

"Take Leah Williamson, she was Nike's poster person, and later next minute she's never playing.

She obviously has come back and is an outstanding athlete, but the commercial and career opportunities that she loses in that snap second.

.

.

"While studies show there has never been an increase in ACL injuries in female soccer over the last 20 years, and ACLs sole account for 2% of time-loss injuries in elite female soccer, women are up to eight times extra susceptible to suffer the injury than their male counterparts.

Australia and Chelsea forward Sam Kerr, considered one of the best goalscorers in the fixture, is one of the staggering 500-plus elite female stars who have torn their ACLs since 2022.

She suffered the injury in early 2024, and has never played since.

While an elite female squad can expect one ACL injury per campaign, Arsenal were severely impacted when they lost four stars, with Williamson, over six months in 2022-23.

Forward Beth Mead was one of the four.

She also missed the 2023 World Cup but is back with England at the Euros, dedicating the tournament to her late mother June, who died of cancer two months after Mead tore her ACL.

She has been vocal over her mental health struggle which is now an issue for stars amid ACL recovery, but was amplified with the death of her mum.

"Since of the injury I couldn't play soccer, which was always my escape, my happy place," Mead said.

"Moments when people thought I was fine since of my outgoing personality, were very dark.

"'Multiple FACTORS'Culvin, who is also a senior lecturer at Leeds Beckett University, stressed research into ACL injuries must look at the bigger picture.

"People want a quick fix, and what we're saying is ACL injury is multifactorial," she said.

"We can't say it's workload, or we can't say it's the way women run or they land, or they jump, or whatever it is.

We're saying that there's so multiple factors that go into it that it's really hard to determine one or two factors, we want to look at in a holistic sense.

"Culvin is part of Project ACL, a three-year study launched by FIFPRO, the Professional Footballers' Association, Nike and Leeds Beckett University that is focusing on England's Female Super League, but plans to expand to study other leagues as well.

"There's a mismatch between levels of professionalization and the expectations on stars to excel in substandard environments.

And the big one for us is looking at environments as modifiable risk factors," she said.

"Obviously you've got non-modifiable risk factors which are predominantly physiological, but you've got modifiable risk factors which count for calendar, number of matches, travel and later actual physical environments that stars play in, and the working environments, and that's what our focus is for this research.

"A FIFA-funded study at Kingston University is investigating if fluctuations amid menstrual cycles could be contributing to the career-threatening knee injuries.

While experts discount the notion of an epidemic in elite soccer, UEFA's chief medical officer Zoran Bahtijarevic said numbers are on the rise at the youth level as girls flock to the fixture.

A recent study by Nielsen Sports and PepsiCo found that athlete growth among girls has soared, particularly in Asia, with China seeing a 300% rise, and Europe, led by France at 150%.

"We can expect an epidemic of ACL injuries somewhere else, below the radar, with the explosion of participation," Bahtijarevic told Reuters.

"The peak of injuries in women is between ages of 15-16 and 19.

These go undetected, since these girls are never big stars.

"