Last September, a journalist asked Manchester City’s talismanic midfielder, Rodri, about rising injuries in men’s football. Did he think footballers would end up refusing to play – or even going on strike – over the number of games they now play?
Rodri paused for about 0.1 seconds before answering. “Yes, I think we’re close to that,” he agreed. “I think if you ask any player, he would say the same… If it keeps [going] this way, there will be a moment where we have no other option.”
It was a strong statement, underscored by what happened just five days later. During a 2-2 draw with Arsenal that weekend, Rodri went down with a knee problem. It turned out to be a bad one.
“Unfortunately, we got the worst [news],” Man City manager Pep Guardiola confirmed afterwards. “He had surgery this morning – ACL and some meniscus [damage]… This season is over for him.”
What’s so serious about an ACL rupture?
If ACL tears have come to be known as the “most dreaded injuries in football”, there are a couple of good reasons for that. One, the ACL is central to the structure and function of the knee: it runs from the thigh bone to the shinbone, providing forward and backward movement, and general stability. Two, tears can be tricky to treat. Much depends on the severity of the rupture. A partial one might be tackled with rest, physiotherapy, specific exercises, and potentially a brace. But rehab may still take time and the ligament may never fully recover. Severe tears could need ACL reconstruction – particularly if the injury causes ongoing instability, comes with other injuries (which is common), or happens to someone who is highly active (such as footballers). But recovery is lengthy: Rodri, for example, was in rehab for eight months.
Are ACL tears on the rise in football?
They have certainly gone up this year. There were four ACL injuries in the whole of the 2023/24 Premier League season. By April 2025, this season’s total had risen to 11. And some of those were to high-profile stars, such as Arsenal’s Gabriel Jesus and Manchester United’s Lisandro Martinez. The ages of the injured range from 19 to 30, and the list includes defenders, midfielders and strikers. So it’s not as if the injuries have been restricted to older players or specific positions. The rise is even more stark in women’s football, as we explained on the blog last year. Globally, nearly 200 elite female players are thought to have suffered ACL injuries over the previous 18 months – a huge number.
Are footballers playing too many games?
Interestingly, a 2024 study by the CIES Football Observatory suggested that, compared to a decade ago, most professional footballers aren’t actually playing more games. The average player today is involved in about 23 games per season. Only 5% of clubs were involved in more than 60 games per season, and just 0.31% of players featured in 61 or more. And though the number of matches has risen overall, larger squads and more subs (teams can now make five changes per match rather than three) mean the load is more evenly spread. But is the number of games the best measure of the problem? Not necessarily!
What else could be driving the spike?
If you looked at the sport-related ACL tears we see here at Chris Bailey Orthopaedics, you’d find almost all of them occurred during football or skiing. Are footballers and skiers just unlucky? Probably not. Most ACL tears happen through sudden twists, turns or abrupt stops rather than direct impacts. A classic example is when a foot “plants” in the turf (as happened to our case study patient Robb), or when a player suddenly cuts in from the wing at speed. So the type of movement that happens in football makes players more susceptible to ACL injuries.
Are there any other hidden factors?
There may be, and researchers are beginning to look at other potential triggers, from the intensity of modern training programmes to outsoles and playing surfaces. “Soccer is an increasingly athletic sport,” adds Guardiola’s long-term surgeon, Dr Ramon Cugat, speaking to BBC Sport earlier this year. “The number of accelerations, decelerations, jumps and contacts increases with each passing season. [And] there are many more factors that go into an anterior cruciate ligament injury. The type of shoe, the state of the grass, the mental health of the athlete – the list goes on, and we are convinced that we have not yet discovered all the aspects that play an important role in the injury.”
What can we do about it?
More research is needed – and fortunately that’s a view shared by governing bodies like Fifa. Last month, for example, they announced a year-long study into ACL injuries in women’s pro football (statistics suggest female footballers are up to six times more likely to suffer ACL tears than their male counterparts). That follows a three-year UK study, Project ACL, which is now scrutinising the key risk factors for ACL ruptures in more detail. So things seem to be moving in the right direction. Will the players putting their bodies on the line feel enough is being done? That remains to be seen. But the science of ACL injuries is improving as the quality of research increases – and that’s an encouraging development.
Find out more about ACL injuries
Interested in reading more about ACLs and how they can be treated? You may find these articles helpful…
Will my ACL be the same after reconstruction surgery?
