In Arsenal's fixture against Manchester United in the Women's Super League, England captain Leah Williamson was substituted 15 minutes into the game with what looks to be a serious knee injury. Worrying for fans, team mates and Leah herself with the Women's World Cup just around the corner.
But what is an ACL injury and why do they seem to be becoming more common lately, especially in women's football?
What is an ACL injury?
An ACL injury is a tear or sprain of the anterior cruciate ligament (ACL), which is one of the key ligaments that help stabilize the knee joint. The ACL connects the thighbone (femur) to the shinbone (tibia) and is located in the knee joint. ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing, such as basketball, football, and downhill skiing. A tear may be partial or complete. Symptoms of an ACL injury include pain, swelling, and instability in the knee joint. Treatment for ACL injuries depends on the grade of the injury, the patient's age, and level of athleticism, and may include non-operative or surgical treatments.
ACL injuries are typically graded on scale of I-III. I being mild damage, II being a partial tear and III being a complete rupture. ACL injuries can be treated through physiotherapy and exercise but usually a grade III tear/rupture requires surgery to reattached it (often known as an ACL reconstruction or ACLR).
A number of high profile footballers have suffered them in recent years, such as Liverpool's Virgil Van Dijk after a clash with Jordan Pickford in the 2020/21 season and more recently Arsenal Women's Beth Mead in November 2022.
The prevalence of ACL injuries in women's sport are significantly higher than that in men's sport and the exact reason behind this isn't fully understood. ACL injuries could be more common in women due to several factors. Women's joints, including the knee, generally have more looseness and range of motion than men's, which can lead to more instability and put them at a higher risk for an ACL tear if the ligament gets overstretched. Women also often have less muscle mass around the knee, which can contribute to instability. Additionally, the female pelvis is wider, which changes the mechanics of how the thigh bone, tibia, and femur function, putting more stress on the soft tissues that support the joints and leading to either a chronic or acute injury. Statistics show that female athletes are 2 to 10 times more likely to experience an ACL injury than men.
The anterior cruiciate ligament is usually injured when excessive strain is put on the knee, often during twisting and movements involved in changing direction or landing.
How is an ACL rupture teated?
ACL reconstruction surgery is a common orthopedic procedure that is performed to repair a torn anterior cruciate ligament (ACL) in the knee joint. The surgery involves replacing the torn ligament with a tissue graft, which is usually taken from the patient's own body or from a donor.
The procedure is typically performed under general anesthesia and can take several hours to complete. After the surgery, patients are usually required to wear a knee brace and use crutches for several weeks to protect the knee joint and allow it to heal. Physiotherapy is also an important part of the recovery process, as it helps to strengthen the muscles around the knee and improve range of motion. Recovery from ACL reconstruction surgery can be a long and challenging process, but with proper care and rehabilitation, most patients are able to return to their normal activities.
Recovery times are typically 2-9 months following ACL surgery with return to sport slightly longer. A high percentage of footballers unfortunately do not return to the same level of performance as they did pre-injury. This is not always the case at top level sport due to their access to high level medical care and daily access to physiotherapy.
So what does this mean for Williamson's World Cup hopes?
Unfortunately it's not looking good...
Her exact injury has not been confirmed by the Arsenal medical team as investigations will still be ongoing. But judging by the mechanism of injury and the way she reacted, it's likely she may have suffered an ACL injury of some extent. If she is required to have surgery, it's likely she will miss the Women's World Cup in the summer of 2023.
I'm sure we've all got our fingers and toes crossed that the injury isn't as bad as first feared and Leah is back on the pitch in time for the World Cup!
If you would like to learn more about ACL injuries or are recovery from one yourself, you might find my rehabilitation programme helpful below. I explain the injury in more detail, how to manage it and have also included a progressive exercise programme to get you back on your feet. It's an instant download so you are able to access it straight away on your phone, tablet or computer.