The heavy toll of muscle and ligament injuries in professional football : Focus on ACL tears

In professional football, athletes face high risks ofinjury, particularly muscular and ligament injuries. Among these, anteriorcruciate ligament (ACL) tears are particularly concerning due to theirseverity, lengthy recovery periods, and the significant economic impact they impose on clubs.

A Severe and costly setback

Muscle injuries account for approximately 30% of all injuries in professional football (Ekstrand et al., 2011). Among these, the hamstrings, quadriceps, and adductors are the most frequently affected. A comprehensive UEFA study covering over 3,000 injuries over an 11-year period revealed that muscle injuries constitute around 25% of the total injuries, with an average recovery time of 17 days per injury (Ekstrand et al., 2013). Although these injuries are relatively common and typically less severe than ligament damage, their recurrence poses a major challenge. Approximately 16% of players who sustain a muscle injury experience a second one within the same season, highlighting how these injuries can disrupt players' performance continuity and long-term physical health.

ACL injuries, on the other hand, represent some of the most severe setbacks in professional football. These injuries often require surgical intervention, followed by a long rehabilitation period, with recovery times ranging from six to twelve months (Granan et al., 2009). Due to the severity and lengthy rehabilitation process, ACL tears are highly feared by players and clubs alike. Recent data reveals an upward trend in ACL injuries among elite football clubs. Between 2020 and 2023, several European clubs have witnessed an alarming rise in serious ACL injuries. At FC Barcelona, for example, four players, including two key starters, suffered ACL ruptures between 2021 and 2023, significantly impacting the team’s competitiveness in European tournaments. At Real Madrid, three players sustained ACL injuries over the 2020–2022 seasons, including Marco Asensio, whose injury in 2020 kept him sidelined for nearly a year. Similarly, Liverpool’s Virgil van Dijk suffered an ACL tear in 2021, which greatly affected the team’s defensive performance, leading to a disappointing season in 2020–2021. 

According to UEFA data, every professional football team experiences an average of one to two ACL injuries per season, with full return-to-play rates estimated at only 55–75% (Waldén et al., 2016). Younger players, particularly those under 25, are at an increased risk of re-injury,with a higher probability of reinjuring the same ligament within two years of the initial injury. Between 2022 and 2024, top European clubs recorded approximately 30 to 40 ACL injuries each season across the five major European leagues (Premier League, La Liga, Serie A, Bundesliga, and Ligue 1). In 2023 alone, there were roughly 35 reported ACL injuries in these leagues, reflecting a consistent trend in recent seasons.

Economic impact on clubs and long-term player performance

The economic impact of ACL injuries is substantial for football clubs. According to Ekstrand (2013), a European professional football team typically spends between €500,000 and €1 million per season on injury-related costs. ACL injuries, due to the extended time players spend off the field and the high costs associated with surgery and rehabilitation, are among the most expensive. For key players, such as Liverpool’s Van Dijk, the economic impact extends to performance-related revenue losses, including missed titles and potential reductions in sponsorship deals. Besides direct medical expenses, clubs frequently have to invest in temporary replacements, adding further financial strain. Following Van Dijk’s injury, Liverpool was forced to make emergency signings to reinforce its defense during the 2020–2021 season, spending several million euros in the process. Additionally, a player’s transfer value can drop significantly following an ACL injury; research by Della Villa et al. (2020) shows that players returning from ACL injuries experience an average 10–15% decline in transfer value.

Beyond individual careers, muscular and ligament injuries have a profound effect on team performance. A study by Ekstrand et al. (2020) demonstrated a clear correlation between lower injury rates and higher league standings. Clubs with fewer injuries consistently perform better in championships and are more likely to win major titles, such as the Champions League. For ACL injuries, the consequences are even more pronounced. Researchby Della Villa et al. (2020) indicates that players recovering from ACL tears often display reduced athletic abilities, with noticeable declines in acceleration, speed, and agility. Additionally, studies have shown that players returning from ACL injuries are less likely to maintain a high-level career within five years of the initial injury.

Psychological impact and the need for preventive technology

Another aspect to consider is the psychological impact of severe injuries, such as ACL tears. Players often become more cautious upon returning, as fear of re-injury may prevent them from taking risks, thereby indirectly affecting their overall contributions on the field.

Given the serious impact of both muscular and ligament injuries, especially ACL tears, on players' performance and club finances, the importance of preventive measures and injury management cannot be overstated. Tools such as the digital twin technology developed by PrediTwins offer new avenues for injury prediction and risk assessment. By enabling real-time monitoring of players’ physical states, PrediTwins allows trainers to better manage training loads, reduce injury risk, and extend the careers of high-performing athletes, thus addressing a critical need in professional football.

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