Major ACL study targets the injury pattern reshaping women’s football
The Football Association and WSL Football have launched a substantial research project to explain why ACL injuries occur so often in women’s football and to identify practical ways to reduce them. Funded by the FA, the PhD study will be run with Imperial College London and sports knee surgeon Simon Ball, with researcher Hanna Lehtovirta leading the work across clubs in the Women’s Super League and WSL2.
The scale of the problem is already obvious on the pitch. ACL injuries are among the most serious setbacks in the women’s game, often removing players from competition for months and forcing long rehabilitation periods that can alter careers, squad planning and medical workloads. Vivianne Miedema, Beth Mead, Leah Williamson and Sam Kerr have all suffered the injury in recent years, a reminder that this is not a fringe concern but a recurring elite-sport threat.
Research has suggested female footballers are two to six times more likely than male players to sustain an ACL injury. The causes are rarely singular. Anatomy, hormones, biomechanics and environmental factors have all been proposed, yet the daily interaction between those variables inside a high-performance football environment remains poorly mapped. Training intensity, fixture congestion, pitch conditions, psychological strain and recovery habits can all converge on the same vulnerable ligament.
Player data and lived experience will be studied side by side
The project is designed to examine the injury problem from both a scientific and a practical angle. Every WSL and WSL2 club will be invited to take part, including players as well as medical, performance and coaching staff. That breadth matters because ACL risk is not confined to one position group or one medical department; it sits inside the whole ecosystem of elite football preparation.
Phase one will use player surveys to gather data on injury history, training load, match load, and hormonal, nutritional and psychological factors. The study will compare data from players who have suffered ACL injuries since the 2018-19 season with data from those who have not. In plain terms, the design seeks to place injured and uninjured players side by side and look for meaningful differences in exposures that may have accumulated before the ligament failed.
Phase two will turn to interviews with players and staff to explore perceptions of ACL injuries and existing approaches to training and prevention. This is where the project can move beyond spreadsheets. The way players describe fatigue, confidence, recovery, menstrual-cycle management or the pressure to keep training through discomfort may expose gaps that injury surveillance alone cannot capture. In a sport where the body is repeatedly asked to sprint, decelerate, pivot and absorb contact, subjective experience can be clinically useful rather than merely anecdotal.
One sentence explains the stakes better than any slogan: an ACL rupture can change a season in a single movement.
By combining quantitative data with the testimony of those living inside elite football, the project aims to produce one of the most comprehensive examinations of ACL injury in the women’s game. The logic is sound. A ligament does not fail in isolation; it fails within a load environment shaped by muscle fatigue, movement patterns, recovery status and possibly biological variation across the menstrual cycle.
Hormonal hypotheses now sit alongside the training-load question
In April 2025, Fifa also announced funding for research into whether hormonal fluctuations during menstrual cycles may be contributing to the rise in ACL injuries in women’s football. That parallel effort shows how the field is widening. The hormonal question has attracted attention because ligament laxity, neuromuscular control and recovery responses may vary across the cycle, although the extent and practical significance of those changes still need careful study in real players rather than in abstract models.
The new FA-backed project does not isolate one explanation at the expense of others. Instead, it treats ACL injury as a multifactorial event, with risk potentially shaped by the overlap of biology, workload and behaviour. That approach is important because prevention strategies built on a single explanation often fail once they meet the messiness of an actual season. A player returning from illness, a congested schedule, a change in strength training, or a psychologically stressful period may all alter the injury equation even when the headline risk factors look similar on paper.
For club doctors, physiotherapists and performance staff, the practical value will lie in whether the findings can inform better screening, training design, rehabilitation planning and return-to-play decisions. For players, the most meaningful outcome would be fewer ruptures and fewer long absences from the game they are trying to build. The project also has the potential to sharpen welfare conversations around workload monitoring and prevention strategies in elite women’s football, where the competitive demands have risen faster than many support systems.
The study has another important feature: it is embedded in the women’s game rather than imposed from the outside. That should improve the relevance of the questions being asked and the usefulness of the answers.
Still, the limits are clear from the outset. Surveys rely on accurate recall, injuries recorded since 2018-19 will reflect changing standards of diagnosis and reporting, and interviews can reveal perception more readily than causation. The work may identify patterns, but proving exactly which mechanism drives the excess ACL burden will remain difficult. Even so, a study of this scale can move the conversation from broad concern toward better-targeted prevention, and it can do so using the realities of professional women’s football rather than assumptions borrowed from elsewhere.