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The Rise of ACL Injuries in Modern Football

Damage to the anterior cruciate ligament has unfortunately become more common in football, especially in women’s football. Why are ACL injuries becoming more frequent in beautiful game and how can technology be used to combat said injuries?

The ACL is one of four cruciate ligaments located in the knee; it connects the femur to the tibia through the centre of the knee. This stabilises the knee while moving. Located in the middle of the joint it sits next to the posterior cruciate ligament. It is a short, thick, powerful ligament about the length of a little finger that is attached to the thighbone and skin bone. The ACL is the main ligament used when planting and cutting, a common foot manoeuvre to fake out an opponent. It is also the most commonly injured cruciate ligament. When it tears or ruptures, it causes devastating injury.

The ACL became known in football circles when England’s Italia 90 hero, Paul Gascoigne of Tottenham Hotspur, ruptured his in the 1991 FA Cup final. It was big news as Gazza was about to join Serie A team Lazio in a multi-million-pound deal. The Italian club reduced the transfer fee they offered because of the ACL injury. ACL injuries happen a lot in this sport; the more you play the greater the risk of injury. Today’s prevalence of ACL tears is partially attributable to increased training, practice and playing time which places a far too heavy workload on an athlete’s body.

In addition to increased workload, demands on modern footballers at the elite level are extremely gruelling; players today are also bigger, faster and stronger than ever before in sports history. While one might think these attributes help, protect a player against injury that is not always the case. Usually when an athlete’s ACL, ‘goes’ there is no one near them. Running with a sudden change of direction or an awkward landing has seen players end up on the ground in pain. When coupled with that threat with a player’s size and increasing velocity, it can even further exacerbate a footballer’s ACL tear risk.

While both male and female athletes can suffer ACL injuries, research in sports medicine has shown that female athletes are at greater risk than their male counterparts, as much as seven times higher according to some experts. Male athletes also return to football more quickly than their female counterparts do. Researchers have focused on various biological differences between men and women, such as the fact that women generally have a wider pelvis than men, which can affect the movement of the tibia and the femur, or that they have a smaller notch where the ACL attaches to the femur, which can make them more prone to tearing. Others have said less muscle development in women’s hamstrings and glutes means they place more stress on their ACLs when landing after a jump, increasing their risk of injury.

Consultants painted a bleak picture of a worrying rise in ACL injuries among young people in the UK, where a 29-fold increase from two decades ago shows females are four-to-eight times more at risk and 25 percent less likely to return after recovery. In the lead-up to the 2023 FIFA Women’s World Cup in Australia and New Zealand, between 25 and 30 players, enough for an entire squad, were missing the Women’s World Cup due to ACL tears. Some notable absentees included England’s Leah Williamson, Beth Mead, Canada’s Janine Beckie, France’s Delphine Cascarino, Marie-Antoinette Katoto, America’s Christen Press, Catarina Macario and Netherlands’s Vivianne Miedema.

ACLs continue to perplex experts and so solving the problem remains a moving target. Physiological, biomechanical and environmental factors are all at play and range from body types to how an athlete runs and jumps, to what quality of surface they play on. The good news is that quantifiable progress is being made to prevent ACL injuries. Football Australia introduced a programme called ‘Perform+’ which can be worked into warm-ups, that has reduced injuries including ACLs by 40 percent and crucially it is not just for elite players. There needs to be a concerted and collaborative effort to tackle the problem from the players and their unions, up to club teams and national and international federations.

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