Anterior Cruciate Ligament (ACL) Injuries in Football: Key Facts
ACL injuries have long been a concern in football, sidelining some of the sport’s top players. In the past, such an injury often marked the end of a player's career. However, advancements in medical treatment and surgical techniques have significantly improved recovery times, allowing players to return to peak performance. Leading orthopedic surgeon Professor Sanjiv Jari discusses how modern interventions aid quicker recovery from ACL injuries.
The Emergence of ACL Injuries in Football
ACL injuries gained prominence in football when Paul Gascoigne, England’s Italia '90 hero, suffered a ruptured ACL during the 1991 FA Cup final. This high-profile injury impacted his planned move to Lazio, leading the Italian club to revise its transfer fee offer.
The anterior cruciate ligament is crucial for knee stability, linking the thigh bone to the shinbone. It enables controlled movement, allowing the knee to twist and turn as a single unit. Damage to the ACL is one of the most severe injuries in football.
A Recent ACL Injury in Football
In the 2024/25 Premier League season, Manchester City’s Ballon d’Or winner, Rodri, suffered an ACL injury during a match against Arsenal. A subsequent MRI scan confirmed additional damage to his meniscus, highlighting the complex nature of ACL injuries.
The ACL prevents excessive forward movement of the shin relative to the thigh and restricts extreme rotation at the knee joint. It is positioned centrally, adjacent to the posterior cruciate ligament.
How Do ACL Injuries Occur?
ACL injuries are common in football and typically occur without direct contact. A sudden change in direction, an awkward landing, or a sharp twist can lead to a rupture. However, high-impact tackles, such as the one that injured Virgil van Dijk against Everton, can also cause ACL damage.
Due to the force required to tear the ACL, additional knee structures like the meniscus or medial ligament are often affected. Statistics indicate that female athletes are 2 to 7 times more likely to suffer ACL injuries than their male counterparts. Factors such as anatomical differences and landing techniques may contribute to this disparity. Injury prevention programs have been introduced to mitigate these risks in women’s football.
Variability in ACL Injuries
Diagnosing an ACL injury within the first 48-72 hours can be challenging due to swelling. Initial treatment focuses on reducing pain and inflammation using ice packs and physiotherapy. Once the swelling subsides, stress tests and MRI scans help confirm the extent of the injury. In some cases, arthroscopy—a procedure using a small camera inside the knee—may be required for a definitive diagnosis.
Treatment and Recovery
The severity of the injury and a player’s level of activity determine the treatment approach. Minor ACL injuries may be managed with physiotherapy and bracing. However, most professional footballers require reconstructive surgery to restore stability and function.
A study conducted from 2001 to 2015 across 78 teams in 16 countries revealed that ACL injuries remained prevalent, occurring 20 times more frequently in matches than in training. Nearly 99% of players with complete ACL ruptures required surgery, with an average recovery time of 6.6 months for training and 7.4 months for match play. While 85.8% of players returned to professional football, only 65% maintained peak performance levels after three years.
Final Thoughts
A torn ACL is a significant injury, but modern rehabilitation techniques have improved recovery outcomes. However, further research is needed to determine how injury recurrence affects long-term performance, which positions and age groups are most vulnerable, and at what stage of the season these injuries are most prevalent. Addressing these questions could help reduce ACL injuries and improve player safety in football.
