A 208-case analysis from the 2022–2024 seasons

(Hampstead et al., JSAMS, 2025)

AI generated summary:

Objective

This study examined when during a match anterior cruciate ligament (ACL) injuries occur in professional women’s football, aiming to clarify whether these injuries are more linked to acute fatigue and intensity rather than cumulative fatigue.

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Methods

• Retrospective analysis of 208 ACL injuries sustained during official matches (2022–2024) across 27 professional leagues and international competitions.
• Injury data were verified through media reports, official statements, and match videos to determine the exact minute of injury.
• Kaplan–Meier survival analysis was used to model the risk of ACL injury over playing time.

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Key Findings

• 70% of ACL injuries occurred within the first 45 minutes of effective play.
• Half (50%) took place within the first 28 minutes.
• The likelihood of an ACL injury dropped to 25% in the last 40 minutes of a match.
• Midfielders had the highest injury proportion (37%), followed by defenders (30%), forwards (27%), and goalkeepers (6%).
• The timing pattern was similar in both halves, suggesting the 15-minute halftime break had no protective effect.

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Interpretation

These results contradict the idea that ACL injuries stem mainly from cumulative fatigue over the course of a match. Instead, they indicate that early-game phases (15th–35th minute) — characterized by high-intensity running, frequent accelerations/decelerations, and intense cognitive load — are the highest-risk period. This points to acute or transient fatigue, possibly coupled with suboptimal neuromuscular readiness, as a stronger contributor.

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Practical Implications

• Prevention programs should target the early phase of matches, improving players’ ability to handle intense activity from the start.
• Training should emphasize neuromuscular readiness, fatigue resistance, and mechanical load tolerance during high-intensity bursts.
• Future research should explore contextual factors (e.g., tactical pressure, match importance, warm-up quality) influencing early-match injury risk.

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Conclusion

ACL injuries in professional women’s football most often occur early—between the 15th and 35th minutes of play. This suggests that acute fatigue and high mechanical load, not accumulated fatigue, are primary risk factors. Preventive strategies should therefore focus on early-match preparation, neuromuscular activation, and readiness for high-intensity demands.