When Barcelona announced that midfielder Pablo Gavi would undergo an extended period of rehabilitation due to a serious knee injury sustained during Spain’s victory over Georgia, sports enthusiasts raised questions about the recent surge in top professionals facing similar setbacks.
The 19-year-old midfielder, enjoying a stellar start to the season, is poised for a prolonged recovery akin to Real Madrid stars Thibaut Courtois and Eder Militao, who also suffered anterior cruciate knee ligament (ACL) damage during pre-season training.
This unfortunate trend extends beyond them; players such as Villarreal’s Yeremy Pino, Arsenal’s Jurien Timbers, Chelsea’s Christopher Nkunku, and defender Wesley Fofana have all grappled with ACL injuries within the last six months. Aston Villa’s Tyrone Mings also succumbed to a serious ACL injury on the opening day of the Premier League season.
The 2023 Women’s World Cup (held in Australia and New Zealand) witnessed 30 top players, including Arsenal’s Vivianne Midema and Beth Mead, missing the tournament due to ACL tears. The 2023 Rugby World Cup, won by the Springboks, featured the notable absence of France’s fly-half Romain Ntamack, sidelined by a ruptured ACL.
While this surge in ACL injuries might seem like a mini-pandemic in top-level sports, experts contend that there is insufficient evidence to suggest an increase in its prevalence. Nevertheless, a conspicuous imbalance remains, prompting questions about why this injury has become so widespread in sports and what measures the sporting world needs to take to address this growing concern.
FLOS explores this issue, seeking to unravel the mystery behind what is fast becoming a pandemic in the world of sports.
Understanding ACL
The Anterior Cruciate Ligament (ACL) is a short, thick, powerful ligament within our knees that connects the thigh bone to the shin bone. When torn or ruptured, it results in a devastating injury that requires surgery and a lengthy rehabilitation time frame to gain full recovery.
Studies focused on football indicate that women are six times more likely to suffer ACL injuries compared to men and 25% less likely to return after recovery.
Causes of ACL Injuries
Research suggests that societal attitudes toward female sports participation may contribute to the higher risk of ACL injuries in women. Muscle strength imbalances, particularly noticeable in females, are another cause of the injury’s prevalence. This could explain why structured injury prevention warm-ups, incorporating strength and balance, prove effective in reducing ACL injury risks for young girls.
Anatomical differences in women at an older age and changing hormones during menstrual cycles are also considered possible contributing factors.
Other theories point to women playing in boots designed for men, with reports indicating discomfort in as many as 82% of surveyed female players in Europe.
The explosion in the game’s popularity and the increase in the schedule are additional factors. The increased frequency of fixtures has placed harsher demands on athletes’ bodies, particularly affecting females who may not have received the same elite training as boys at an early age. In this piece we further into the impact of the football schedule on ACL injuries among athletes.
Impact of the Football Schedule
A FIFPRO report from the 2022/23 season stated that there have been an unprecedented amount of domestic and international competitions, expanded national team tournaments, and travel for footballers.
Players such as Vinicius Junior and Jude Bellingham have played as much as double the competitive professional football at their age as their peers in previous generations, increasing the risk of injury and burnout, according to the report.
Vinicius Jr has at age 22 already played 18,876 minutes of club and national team football, more than twice as much as former Brazil playmaker Ronaldinho at the same age.
Spain’s Pedri had at the age of 20 played more than 12,000 minutes, 25% more minutes than Xavi at the same age.
France’s Kylian Mbappe has at age 24 played 26,952 minutes, 48% more minutes than Thierry Henry at the same age.
Jude Bellingham will have played more than 30% more minutes of competitive football by his 20th birthday later this month than Wayne Rooney, at the same age.
So far, football stakeholders have disregarded health safeguards in favour of competition expansion, which is expected to generate extra revenue. In addition, the report shows that for the 2024/25 season, due to the expansion of the UEFA Champions League and FIFA Club World Cup, there could potentially be an 89-game season for players in the most successful clubs, meaning they could face up to 11% more games. As the game continues to expand, it is clear that the risk of injuries (particularly of this nature) will likely increase.
A study reported by ESPN has linked the growing football schedule to injury severity among players.
Given players now have little time to recover after matches and are straight thrown into the next fixture, existing injuries are increasingly aggravated.
Proposed Solution
Despite the football stakeholders’ focus on increasing fixtures for financial gain and fan satisfaction, FLOS recommends prioritizing neuromuscular training programs, which are proven to reduce ACL injuries. However, adherence to these programs remains a challenge, with only 1 in 5 ACL-injured football players reporting their use. Additionally, attention should be directed towards teams undergoing coaching changes and players moving to higher divisions, as they appear to face an increased risk of ACL injuries, warranting further investigation.
