The Rising Tide of ACL Injuries in Football: Analyzing The Impact of Excessive Match Fixtures and Competitions

By Suleiman Abdultawab

INTRODUCTION

The 2023/2024 football season witnessed a significant increase in anterior cruciate ligament (ACL) injuries among professional players across various leagues, with ten from the English Premier League alone and the trend seems to be continuing into the 2024/2025 season. ACL injury is one of the most devastating injuries for an athlete, specifically in professional football, where sudden directional changes and intense physical contact are frequent. Several high-profile players have fallen victim to ACL injuries in recent seasons, raising questions about the impact of excessive match fixtures and competitions on player’s health and the long-term effects on their careers.

RISING ACL INJURIES: A GROWING CONCERN
During the 2023/2024 football season, numerous players across major European leagues and international tournaments suffered ACL injuries, from goalkeepers to strikers, unmasking the devastating impact of ACL injury across football’s spectrum. Prominent names such as Thibaut Courtois (Real Madrid, Belgium), Jurrien Timber (Arsenal, Netherlands), Gavi (Barcelona, Spain), Neymar Jr. (Al-Hilal, Brazil), and Leah Williamson (Arsenal, England), among others, all faced long-term layoffs due to ACL ruptures.

Interestingly, it is quite rampant in women’s sports; to illustrate, between 25 and 30 players available for an entire squad missed the Women’s World Cup last summer because of ACL tears. As the 2024/2025 season unfolds, several players have also succumbed to similar injuries early on, reflecting a worrying pattern.

In 2022, FIFA’s decision to hold the World Cup in Qatar during the middle of the season compressed the 2022/2023 club calendar, which led to subsequent seasons. This development unsurprisingly has led to fewer breaks for players, leaving them with minimal recovery time between competitions. Furthermore, the growing commercial demands on clubs to participate in international tours, particularly in pre-season, often cause players to compete in high-intensity matches before they are of full fitness and physically ready for the new season.

Such excessive match schedules put significant strain on the body, particularly on the knees, which are most vulnerable to ACL injuries. Fatigue from overplaying can lead to poor muscle coordination, which, when combined with the rapid movements and changes in direction required in football, heightens the risk of ligament damage. Physiologically, the lack of rest periods, combined with intense physical exertion, increases the likelihood of overuse injuries, or in some cases, reoccurrence. Overexertion can weaken the ACL, which helps stabilize the knee joint. Football players often perform quick changes in direction, jumping, and sudden stops—movements that place enormous strain on the ACL. Without sufficient recovery time, the ligament can tear, leading to months of rehabilitation and, in some cases, surgery.

THE IMPACT OF EXCESSIVE MATCH FIXTURES
The growing intensity of football schedules, particularly after the COVID-19 pandemic, has seen major football leagues compress seasons to accommodate delayed competitions. Additionally, with the introduction of new competitions, such as the UEFA Conference League and UEFA Nations League, and extended formats in existing ones, the tight schedules can lead to insufficient recovery time, increasing the risk of injuries, including ACL tears.

1. Increased Match Frequency: The 2023/2024 season featured a high density of matches
   in domestic leagues, like the UEFA Competitions and the FIFA Club World Cup, which
   have added even more fixtures. Players often participate in domestic league matches, cup competitions, international qualifiers, and tournaments such as the Euros, World Cup, and Nations League, sometimes within a short time frame. According to UEFA, players could face over 60 matches in a single season, leading to physical fatigue and an
   increased likelihood of injuries. 2. Intensity of Play: The competitive nature of football requires players to perform at their
2. . Intensity of Play: The competitive nature of football requires players to perform at their highest levels consistently. The added pressure of competing for positions in clubs and national teams can lead to overexertion, which is a significant risk factor for ACL injuries.

The ramifications of ACL injuries extend beyond the immediate physical impact. Players often face lengthy recovery periods that can last from six months to over a year. Affected players are often unable to compete at the highest level during this time, potentially missing out on crucial career moments, transfers, or contract renewals. Additionally, returning from an ACL injury does not guarantee that the player will regain their previous performance levels. Some players struggle with confidence, mobility, and fitness postrecovery, which can hinder their long-term careers. This downtime can lead to:

1. Physical Limitations: Players may return to the pitch not fully recovered, leading to potential long term complications. Studies indicate that players who have suffered ACL injuries are at higher risk of future injuries, including re-injury of the same ligament.
2. Mental Health Issues: The psychological impact of injury can be significant. Players may experience anxiety and fear of re-injury, which can affect their performance on the field.
3. Career Longevity: Repeated injuries can shorten a player’s career, affecting not only their earning potential but also their legacy in the sport. Clubs may be hesitant to invest in players with a history of serious injuries, impacting their career trajectory.

LEGAL FRAMEWORKS AND PLAYER WELFARE
Regulatory bodies, such as FIFA and UEFA, have established guidelines to promote player welfare. The FIFA Medical Regulations emphasize the need for clubs to implement comprehensive injury prevention strategies, including proper training regimens and recovery protocols (FIFA, 2024). Additionally, the UEFA Club Licensing and Financial Fair Play regulations require clubs to maintain a standard of player care, including managing workload to reduce injury risks. Under the FIFA Regulations on the Status and Transfer of Players, clubs are required to provide adequate medical care and rehabilitation for injured players.

The legal frameworks surrounding player safety are crucial, as they hold clubs accountable for the welfare of their players. Failure to adhere to these regulations could result in penalties, affecting a club’s reputation and financial standing. In England, the Health and Safety at Work Act 1974 also applies, ensuring that employers (in this case, football clubs) take reasonable steps to protect employees (players) from injury. However, the enforcement of these protections in the context of competitive sports, where financial pressures to field star players often outweigh health concerns, remains a challenge.

Additionally, FIFPRO, the global players’ union, has repeatedly raised concerns about the volume of fixtures and the physical toll it takes on players. In its 2021 Player Workload Monitoring Report, FIFPRO recommended that governing bodies consider reducing the number of matches per season to protect player welfare, emphasizing the need for “a human-centered approach to workload management.”

RECOMMENDATION
Some might argue that athletes are ordinarily meant to compete and push themselves to the pinnacle of their physical limits; thus, they know best how much to manage their physical conditions, seeing as they are professionals; that does not, in all fairness, justify the current “condition of work” they are put into.

A comprehensive approach to managing player workloads is necessary to address the rising number of ACL injuries. Organizing bodies like FIFA, FA, other regional bodies like UEFA, CAF, CONEMBOL, and domestic leagues should take immediate steps to reduce the physical toll on players by limiting the number of matches each player can participate in within a season. This can be achieved by introducing player caps for matches, ensuring athletes have ample time for recovery between high-intensity fixtures, and most importantly, this gives rise to other “squad players” to be able to participate and equally have a decent amount of game-time under their belt.

Additionally, FIFA being the umbrella body could introduce an increase in the registered first-team squad size to allow for more rotation and less reliance on key players. A larger squad would provide coaches with more flexibility to rest players without compromising team performance. This would complement the recent increase in match substitutions, which has been a crucial development in reducing fatigue-related injuries. The move to allow five substitutions per game has shown tangible benefits, helping clubs manage player fitness and reduce injury risks. However, further refinement of match scheduling and workload distribution is essential to protect the health and careers of players.

In addition, breaks could also be introduced during games; while this might lead to less playing time in the actual 90-minute duration, it can be complemented during the additional time after the normal 90-minute mark has been played. This was seen in the 2022 FIFA World Cup, where water breaks were introduced, which has since been adopted by other leagues to cushion the effect of the harsh weather and re-energize the players.

CONCLUSION
The increase in ACL injuries among football players from the 2023/2024 season to the current 2024/2025 season underscores the critical need for a reevaluation of match scheduling and player management. Excessive match fixtures and the demands of competitive play are placing unprecedented stress on athletes, leading to detrimental effects on their careers and overall well-being. As the football community grapples with these challenges, a concerted effort is required to prioritize player safety through robust
legal frameworks and effective injury prevention strategies.

The current framework does not adequately address the cumulative impact of excessive match fixtures on long-term player health. Without systemic changes, the careers of top players will continue to be jeopardized by injuries such as ACL tears, potentially depriving the sport of its brightest talents.

REFERENCES
Bourke, H. E., O’Neill, R., & Valiant, J. The risk of future injuries following anterior cruciate ligament reconstruction in professional athletes. Journal of Sports Medicine, 15(3), 225-232. (2023).

Case studies on ACL injuries from the 2023/2024 football season, sourced from The Guardian, BBC Sport, and Sky Sports FIFA, “Regulations on the Status and Transfer of Players,” 2023.

FIFA Medical Regulations: Guidelines for the Protection of Player Welfare . (2024).

FIFPRO, “Player Workload Monitoring Report,” 2021.

Hawkins, R. D., Hulse, M., & Thomas, A. Injury risk in professional football: A retrospective analysis of player match exposure and injury occurrence. British Journal of Sports Medicine, 57(10), 619-625. (2023).

Health and Safety at Work Act 1974 (United Kingdom).

López-Miñarro, P. A., et al. (2023). The psychological impact of ACL injuries on professional football players: A systematic review. International Journal of Sports Psychology, 54(1), 1- 12.

UEFA, “Medical Regulations,” 2022.

UEFA. Player workload and injury prevention: Recommendations for clubs and players. (2023). World Health Organization (WHO), “Global Research on ACL Injuries,” 2022.

Source: thenigerialawyer