Women’s ACL injuries
Why ACL Injuries Keep Happening in Women’s Football And What We Can Do About It
A Serious Problem That Just Won’t Go Away. ACL injuries have become one of the biggest threats to women’s football. Every season, more top players are sidelined with serious knee injuries that can take a year or more to recover from — and sometimes change careers completely.
In just the last couple of years, stars like Sam Kerr, Beth Mead, and Leah Williamson have missed major tournaments after tearing their ACL (anterior cruciate ligament), a key ligament in the knee that helps keep it stable during sudden twists, turns, and stops.
Even though people have started calling it an “epidemic,” experts now say the numbers haven’t actually spiked — the real issue is that women are still much more likely to get this injury than men, and we still don’t fully understand why.
ACL Injuries and UEFA Women’s Euro 2025: A Real-Time Reminder
Following the completion of the UEFA Women’s European Championship 2025 in Switzerland, the tournament itself has become a stark case study in the impact of ACL injuries in elite women’s football. Multiple high-profile players were ruled out either before or during the competition due to knee injuries.
• Switzerland’s Ramona Bachmann, competing on home soil, was sidelined just weeks before the Euros after rupturing her ACL Reuters+3Wikipedia+3ESPN.com+3.
• England’s squad was affected by Ella Morris, also ruled out with an ACL tear, and other absentees such as Millie Bright, while Lauren James was closely monitored throughout the tournament Reuters+4FourFourTwo+4The Guardian+4.
• Germany’s captain Giulia Gwinn suffered a serious knee injury during their opening match—her second ACL-related setback—and missed the rest of the tournament FourFourTwo+6Deutsche Welle+6ESPN.com+6.
The absence of these players not only disrupts team dynamics and tournament narratives—it also highlights how even world-class athletes aren’t immune to ACL risk factors. Their losses underscore how ACL injuries affect both squad selection and the emotional intensity of high
stakes international football.
Furthermore, experts from FIFPRO and UEFA have pointed toward the broader context of increasing match and travel demands—with players logging massive minutes—as a strain on women’s health at the elite level. This reality is playing out in real-time at Euro 2025 and underlines the urgency behind calls for better workload management and pitch standards.
The Stats: Why Women Are at Greater Risk
Studies show that female footballers are between 2 and 8 times more likely to tear their ACL than male players. This isn’t just a small difference, it’s huge.
Some of the most recent research found that:
• Teenage girls (ages 15–18) suffer more than twice as many ACL injuries per year as young men.
• Over 500 elite-level female footballers have torn their ACL since 2022 — that is a lot of careers disrupted, teams affected, and tournaments
changed.
What Makes Women More Vulnerable?
This is where things get complicated but let’s try and break it down…
1. Body Structure
Women’s bodies are built differently than men’s. For example:
• Wider hips create a different angle between the thigh and the knee (called the Q angle), which puts more strain on the knee joint.
• Hormones like oestrogen can make ligaments a bit more flexible, especially during certain phases of the menstrual cycle.
• Some women also have a narrower notch in the femur (thigh bone), where the ACL sits that makes the ligament more likely to get pinched or torn.
2. Movement and Muscle Patterns
Men and women often move differently and that matters in sport.
For example:
• Women are more likely to land from jumps with straight knees and their knees turning inwards, which puts more stress on the ACL.
• They tend to use their thigh muscles more than their hamstrings, and that muscle imbalance makes the knee less stable during fast changes in direction.
3. Unequal Conditions
This part often gets overlooked.
Women’s teams — especially in lower leagues or youth football often have:
• Less access to strength and conditioning training
• Fewer physios and medical staff
• Worse pitches that are harder or uneven, which increases injury risk.
So it’s not just biology — it’s also about how and where the game is being played.
The Hidden Mental Strain of ACL Injuries
An ACL tear doesn’t just hurt the knee it also affects the mind.
• Recovery usually takes 9 to 12 months, and some players never get back to their previous level.
• A large study found that only 55% of women return to full competition, and many say they struggle with fear of re-injury and mental health issues like anxiety or depression.
Top players have spoken about the emotional toll including Beth Mead, who described how lonely and uncertain recovery can be.
So, What’s Being Done?
Injury Prevention Programmes
There is good news: we know how to reduce the risk, and the tools are out there.
Exercises like FIFA 11+ or Knee Control — when done regularly can cut ACL injuries by 30 to 50%. These include:
• Balance drills
• Jumping and landing technique
• Strength work for hips, glutes, and hamstrings.
More teams are using these, especially in top leagues — but they are not yet common at grassroots level or in school sports.
New Research in Progress
Some exciting studies are happening now:
• Project ACL is looking at how pitch quality, match schedules, and training loads affect injury risk.
• Kingston University is studying how hormone levels might change the way women move throughout their cycle.
• Duke University in the US is running a multi-million-dollar project looking at how women’s anatomy might increase ACL risk.
But so far, there is no clear evidence that a woman is more likely to get injured just because of her menstrual cycle — even though that idea gets a lot of media attention.
Returning to Play And the Risk of Reinjury
One of the scariest parts of ACL recovery is that the first injury isn’t always the last.
• Up to 4 in 10 women will have a re-injury, often on the opposite leg.
• That is why return-to-play decisions now focus not just on fitness, but also confidence, mental health, and stability testing.
Some teams are now offering sports psychology support, but this isn’t standard everywhere and many players still feel under pressure to come back too soon.
Final Thoughts: Where Do We Go From Here?
ACL injuries in women’s football are not going away — but we now understand more than ever.
Here is what needs to happen next:
Prevention programmes like FIFA 11+ should be used in all levels of the women’s game not just with pros. More research funding is needed to answer the big questions. Investment in better pitches, training, and medical care will protect players across all levels. Players need support for both the body and the mind when returning from injury.
ACL injuries don’t have to be the “cost of playing” women’s football. With smarter prevention, more support, and a level playing field, we can reduce the risk and help more players stay in the game they love.
Written by Mr Saket Tibrewal, Consultant Orthopaedic Surgeon.
