This is the first part of my ACL series to understand the injury and its broader impacts in women's football, from what the ligament is to why women are more predisposed to tearing it.
Your ACL, also known as your anterior cruciate ligament, is one of the main stabilising ligaments in the knee.
It connects the thigh bone to the shin bone.
It controls rotational movements and prevents the knee from slipping forward. In football, this is critical because it allows for Hickman changes in direction, acceleration, deceleration, and balance, all of which are essential in the sport.
The ACL’s job is to stabilise the knee, especially during quick movements, which are essential for tackling, jumping and pivoting.
Because football demands sudden changes of direction, deceleration, and one-legged landings, the ACL is under significant stress.
When the ligament is healthy, it acts like a strong internal seatbelt, holding the knee stable through those twists and turns.
When it tears, that “seatbelt” snaps and the joint loses its primary stabiliser.
Without a functioning ACL, players can’t pivot, cut or land without their knee collapsing. The knee becomes unstable, risking further damage to cartilage or meniscus. Even walking downhill or downstairs can feel unstable.
This is why an ACL injury can take players out of the game, sometimes forever, as it directly affects the moves that define the sport.
An ACL tear usually occurs during a sudden, high-intensity move, often a non-contact injury, and sometimes happens instantly during an ordinary action the player has done thousands of times before.
There are many ways it can occur when a player plants one foot to turn sharply, for example, dodging an opponent or cutting inside the upper body and thigh rotate, but the foot stays fixed. The twisting force overloads the ACL, causing it to tear.
After heading the ball or contesting an aerial duel, if a player lands on one leg or with their knee slightly inward (a “valgus” position), the ligament can’t handle the stress. The ACL can rupture instantly on impact.
Another way is when a player is sprinting at high speed and suddenly brakes, especially on a slippery or uneven surface, which can place enormous strain on the ligament.
Though most ACL injuries in women’s football are non-contact (around 88%), collisions can also cause tears, particularly if the knee is hit from the side while the foot is planted.
ACL ruptures are accompanied by a sharp ‘pop’ with immediate pain and swelling, and instantly sideline a player for 9-12 months or even longer if more complications occur. This injury has historically ended people's football careers, but with advances in surgery and recovery, you can get back to the game.
It is a condition that does not heal on its own and requires surgery to reconstruct the tendon.
The recovery is long and involves physical therapy, as a player softens and loses strength, balance, and confidence.
In the 2022/23 season, an ACL rupture occurred every 1,188 minutes in the WSL, compared to every 8,500 minutes in the Premier League.
While this is a shocking statistic, it’s not comparable data. Men and women are scientifically different from DNA to biometrics; therefore, it makes no sense to compare two things that biologically are not the same. Therefore, this data renders, for example, the men’s game unimportant, as it was not banned for fifty years. Also, male footballers likely had and have better resources from a younger age in terms of facilities, coaching, and strength training, which explains why they have less. So these factors all impact the data, but that stark stat doesn’t show why.
Many injuries occur during defensive pressing or deceleration, not during fatigue-related moments.
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