ACL crisis in women’s football: why female players are at greater risk
Women’s football is experiencing an alarming surge in Anterior Cruciate Ligament (ACL) injuries, with research showing that female athletes are two to eight times more likely than men to sustain this devastating knee injury.
A complex mix of anatomical, biomechanical, hormonal, and structural factors - combined with growing match demands and historic neglect - has created what many experts now describe as a health crisis in the women’s game.
In the opening ten weeks of the Barclays Women’s Super League 2025/26 campaign, eight players have been victim to this injury. Something must be done to address this injury crisis and create a safer future for female footballers, without the fear of the ACL striking over and over again.
Anatomical and biomechanical differences
Studies indicate that several physical factors may predispose women to higher ACL risk:
- Wider hips and different joint angles (knee and ankle alignment) can increase ligament strain.
- Smaller femoral notches- the groove through which the ACL passes - may make the ligament more vulnerable.
- Women often display distinct landing and movement mechanics, such as knees collapsing inward during jumps or sudden direction changes.
- Lower hamstring and outer-hip strength in some female athletes may also contribute to instability and overload on the ACL.
These differences mean the ligament is more frequently placed under extreme stress during football-specific movements.
Hormonal influences
Fluctuations in hormones during the menstrual cycle, particularly oestrogen, are being actively explored as a contributing factor. Oestrogen may increase ACL laxity, potentially raising injury risk at specific phases of the cycle.
Major governing bodies, including FIFA, are now funding studies to better understand the role of hormonal variation in ligament vulnerability.
Increased match load and fixture congestion
The rapid growth of women’s football has brought increased visibility - but also heavier match schedules and frequent travel. Many players are now enduring workloads comparable to elite men’s teams without the same infrastructural support.
As a result, bodies are placed under heightened stress, leading to rising injury numbers across leagues.
Equipment and facility disparities
Historically, football boots for women have been little more than scaled-down versions of men’s designs. This lack of gender-specific equipment contributes to:
- Poor fit
- Increased discomfort
- Greater risk of lower-limb injury
Access to elite-level medical care, rehabilitation facilities, and suitable training environments also remains inconsistent across clubs and countries.
Research and ongoing projects
Efforts to address the crisis include:
Studies and funding: Organisations like FIFA are investing in research on hormonal
influences and injury mechanics.
Equipment development: Brands and federations are working on improving boot fit and protective gear designed specifically for women.
Data collection: Researchers are gathering more detailed information about ACL injuries, including mechanisms, circumstances, and recovery trajectories.
The stark statistics
The numbers reveal the scale of the problem:
- Almost half of all ACL reconstructions in the UK are due to football-related injuries.
- ACL injuries have the longest recovery period of any common football injury.
- They account for around one-third of all playing time lost.
A psychological toll accompanies the physical one. Arsenal - at the time - lost and eventually regained Leah Willamson, Beth Mead, and Vivianne Miedema over a twelve-month period.
Chelsea striker Sam Kerr had her entire 2024/25 season cut short, returning only recently after sixteen months out. Just weeks after Kerr’s injury, Chelsea forward Mia Fishel suffered another ACL rupture, fresh off her recovery from the same injury sustained in June 2022. She now plays for Seattle Reign FC.
Defining the ACL
The Anterior Cruciate Ligament is a small yet powerful structure inside the knee, roughly the length of a little finger, connecting the thigh bone to the shin bone. When torn or ruptured, it results in severe damage, instability, and the need for extensive rehabilitation.
Consultant orthopaedic surgeon Nev Davies highlights a concerning trend in young people in the UK: a twenty-nine-fold increase in cases compared with two decades ago, with girls four to six times more at risk than boys. Football-specific injuries have surged in elite women’s sport, with 195 top-level players added to the casualty list in just the past eighteen months.
High-profile absences and the 2023 World Cup fallout
Between twenty-five and thirty players - enough for an entire international squad - missed the FIFA Women’s World Cup 2023 due to ACL ruptures. Notable absentees included: Willamson, Mead, Janine Beckie, Delphine Cascarino, Marie-Antoinette Katoto, Miedema, Christen Press, and Catarina Macario.
Sports medicine expert Dr. Kate Jackson summarised the issue starkly:
“We have known there is an increased ACL injury rate in women and girls for twenty years. There is a nuanced gender issue that needs exploring. We still don’t fully comprehend it. Women are six times more likely to have ACL injuries compared to men and 25% less likely to make a full return.”
Calls for greater investment and accountability
Arsenal and Lionesses winger, Mead voiced frustration in 2023, noting:
“It’s important we, as a collective, try and get more done for ACLs and research into it. It is way too common in the women’s game. If that ever happened in the men’s game a lot more would have been done sooner.”
Researchers like Jackie Whittaker argue that organisations such as FIFA and FIFPRO should fund large-scale investigations-similar to the study commissioned by the NBA and General Electric in 2015 to analyse tendon injuries in basketball. FIFPRO has acknowledged that increased workload, heavy travel, and inadequate rest all contribute to rising injury levels.
But experts agree that acknowledgment is only phase one. Meaningful action must follow.