By Emma Petzoldt
A tearing of the ACL (anterior cruciate ligament) is still considered one of the worst injuries in the world of football. This ligament is a key structure in the knee, connecting the thigh bone to the shin bone. It prevents the shin from sliding forward and the knee from twisting excessively, forming an “X” around the joint.
An ACL injury is a tear or sprain of the anterior cruciate ligament, which most commonly occurs during sports that involve sudden changes of direction, abrupt stops, jumping, and landing, such as football, basketball, American football, and downhill skiing. It is also common to hear a “pop” in the knee when the injury occurs. Recovery typically takes around 7–9 months. ACL injuries are particularly prominent in football; for example, in the 2024/2025 season of the English Premier League, 10 players suffered ACL tears, including Arsenal FC player Gabriel and Manchester City midfielder Rodri. However, ACL injuries are even more common in women’s football due to anatomical and biomechanical factors, which will be explored later.
How common is this injury in men’s professional and amateur football? The truth is: more than we might think. Some of the most famous players who have suffered ACL injuries, including Radamel Falcao, Alan Shearer, Del Piero, Xavi, and Totti. In the 2022–2023 season across Europe’s top five leagues, 101 players underwent reconstruction surgery, with an average return-to-play time of 248 days. Nevertheless, some players did not return, and defenders had the highest non-return rate at 20%.
A study conducted by the European Society of Sport Traumatology, Knee Surgery, and Arthroscopy (ESSKA) found that over a five-year period in German professional and amateur football, 958 ACL injuries were registered. The incidence of injury was highest in amateur football (0.074 per 1,000 hours of football exposure) compared to 0.058 per 1,000 hours in professional football. Overall, men are 2 to 8 times less likely to suffer this injury than women.
Why are women more likely to tear their ACL? Here are several reasons, with two main factors standing out: anatomy and biomechanics. First, anatomy: women generally have wider hips and knees that tilt inward. This alignment alters the knee joint, increasing the risk of injury during jumping, pivoting, and landing. Additionally, ACL tissue in women is often thinner, making it more prone to tearing. Second, biomechanics: women typically land in an upright position with straight knees, while men tend to land with bent knees, which reduces the risk of injury. ACL injuries have become a significant concern in women’s football. For example, in November 2025, just three months into the season seven players had already suffered ACL injuries in the Women’s Super League, with many more occurring in other top-flight leagues worldwide.
To conclude, despite advances in medical technology, ACL injuries remain significant, destructive, and potentially career-ending in football. More research is needed to reduce the incidence of ACL injuries in women, as the situation is increasingly concerning.
