What is the risk of ACL injury while playing football?

ACL injuries are common, serious and can be career-threatening for football players. This systematic review and meta-analysis evaluated twenty-eight studies of ACL injuries in male and female players and attempted to quantify the risk of ACL injuries for players of different genders and participation levels1.

The results of the analysis showed that the incidence proportion (IP) and incidence rate (IR) of ACL injury in female football players were 2.0% (95% CI 1.2% to 3.1%) and 2.0/10 000 athlete exposures (AEs) (95% CI 1.6 to 2.6; I2=91%) over a period of one season to four years, respectively. The IP and IR of ACL injury in male football players were 3.5% (95% CI 0.7% to 8.2%) and 0.9/10 000 AEs (95%CI 0.7 to 1.1; I2=94%).

When controlling for exposure, women had a 2.2 times increased incidence rate of ACL injury compared to men. It would be reasonable to expect that a higher proportion of women would sustain this injury compared to men given the rate of injury occurrence being more than double, however this was not the case. One possible explanation for this may be that men play more than twice as much football. As the number of female football teams are increasing, it is highly likely training and game time for female footballers will also increase. As a result of this increased exposure we may see an increase in the incidence rate in female player.

The higher rate of ACL injury amongst female footballers has remained steady, despite increasing evidence that ACL injury prevention programmes are effective. This may mean that these programmes are not being done and illustrates the need to address barriers to implementing such programmes.

This analysis included studies with a variety of designs, and significant statistical heterogenicity was seen. There was also the inclusion of re-injuries, and some studies only included non-contact mechanisms of injury. This may mean that the findings may be underestimates of the true rates. Regardless this meta-analysis demonstrates the need to include data on both female and male footballers simultaneously to allow for sex comparisons, and to plan appropriate injury prevention strategies.

To learn more about issues relevant to female football player complete the “female athlete” course in the FIFA Diploma in Football Medicine.

11. Montalvo AM, Schneider DK, Silva PL, Yut L, et al. ‘What’s my risk of sustaining an ACL injury while playing football (soccer)?‘ A systematic review with meta-analysis. Br J Sports Med. 2019 Nov;53(21):1333-1340.


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Shahram MohagheghBangoura Recent comment authors
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En sport en general et le football en particulier il n ya pas de risque zero .chez les sortifss une des blessures les plus graves est la lesion du LCA pouvant avoir des effets devastateurs voir meme abandon lorsque le sportif n est pas dans les conditions requises de traitement. Le programme FIFA 11 est un moyen de prevention fes blessures plus particulierement en football. Les risques de lesions du LCA sont plus eleves dans le sport de haut niveau.la pre saison doit etre determinante avec une bonne preparation gage d une prevention dans les cas de lesion ligamentaire en… Read more »


Lire chez les sportifs une des blessures les plus graves est la lesion du LCA
une mauvaise chirurgie peut toujours avoir des repercutions et le sportifs aura toujours du mal a s affirmer

Dr Shahram Mohaghegh
Dr Shahram Mohaghegh

It is important to know the difference between the IR and IP. incidence rate is a measure of the number of new cases (“incidence”) per unit of time (“rate”). Compare this to the cumulative incidence (incidence proportion), which measures the number of new cases per person in the population over a defined period of time.