There is an ACL epidemic in the Premier League – here is why
In normal times, the news that Chelsea midfielder Carney Chukwuemeka required knee surgery this week would be a source of significant concern. Chukwuemeka, after all, is only 19. But these are not normal times in elite football and for the midfielder to be ruled out for around six weeks instead feels like a cause for mild relief.
Strange as it might sound, Chukwuemeka is one of the lucky ones. In recent weeks, an extraordinarily high number of top players across Europe have not been quite so fortunate. The list of stars who have suffered serious knee injuries since the start of pre-season is unusually – and worryingly – long.
At Aston Villa, they have had two anterior cruciate ligament injuries already (Emi Buendia and Tyrone Mings). There have also been two ACL injuries at Real Madrid (Thibaut Courtois and Eder Militao). Arsenal’s Jurrien Timber has suffered an ACL injury, too, as has Chelsea’s Wesley Fofana. Monaco’s Breel Embolo had an ACL rupture earlier this month, while former Manchester City midfielder David Silva has retired after an ACL injury of his own.
Analysis by Ben Dinnery, of Premier Injuries, shows that only four ACL injuries were reported in the Premier League in the entirety of the 2022/23 season, and only five in the season before. This time around, including pre-season, there have already been four.
The issue is not limited to ACLs. Chelsea’s Christopher Nkunku, a £52 million signing from RB Leipzig, has been ruled out until December after surgery on a knee injury that he picked up in pre-season. Arsenal’s Gabriel Jesus has also had a knee operation, although he is expected to be out for weeks rather than months. Kevin De Bruyne has been ruled out for months after surgery on his hamstring.
There is an acceptance within the game that serious injuries are more likely at this time of the season than at any other point of the campaign. This is largely due to the sudden increase in intensity when competitive action begins.
But to see so many issues, so early in the season, is unquestionably strange. Telegraph Sport spoke to one physiotherapist at a Premier League club who was taken aback by the sheer amount of significant injuries already, particularly involving knees.
What, then, is going on? In the eyes of certain managers, including Pep Guardiola and Mikel Arteta, these problems are the result of the enormous physical demand on players. “Look how many ACLs there are,” said Guardiola last week. “They make you go to Asia, to the United States, really tough matches, derbies, big games, and people fall, and they will keep falling and falling, because the show must go on.”
Asked last week about the spate of serious injuries, Arteta said: “There is something there. The games, plus the tours, plus the World Cup in December, plus internationals – it is a lot. It is too much for the players. It is incredibly demanding. When you see the next 36 months of the calendar for those players, it is just better not to look at it, because it is incredible what they are going to have to be doing.”
Maheta Molango, the chief executive of the Professional Footballers’s Association, said that the “number one topic” in his meetings with players and managers is the issue of injury prevention and protection from burnout.
“An increase in player injuries is a natural consequence of an increasingly crowded football calendar that shows no sign of slowing down. Players feel like they are being pushed to breaking point, with one season blurring into the next,” Molango told Telegraph Sport.
“They are saying that they sometimes feel like they are simply focusing on making it through game by game. They have no time for proper recovery and are constantly fatigued or carrying injuries. It is a situation that is just not sustainable.”
When it comes to ACL injuries in particular, the situation is not simple. According to consultant knee surgeon Saket Tibrewal, more research is required for the sporting world to fully understand the cause of such serious knee problems, which are even more prevalent in the women’s game.
“ACL injuries are not really related to fatigue, as far as we know,” said Tibrewal. “More of the injuries happen in the first half of matches compared to second halves, which does not fit in with that theory. We have the National Ligament Registry and we are collecting data to look for trends. In the future we will have a better idea.”
There are theories, of course. One is that this hotter time of the year leads to harder pitches, which could play a role as a firmer surface results in more force going through the leg.
There are also risk factors – “having an ACL injury on one leg puts you at higher risk of getting a second ACL injury on the other,” said Tibrewal – and other possible explanations. One of which, as unsatisfying as it might be, is coincidence. “It could just be bad luck,” said Tibrewal.
Work is being done to find solutions, and to hopefully unearth a way to better protect footballers from these injuries. It is too late for those already on the treatment table, though, and the fear in the game is that this run of injuries is a worrying sign of things to come this season.
“How we predict who it is going to happen to is the tricky bit,” said Tibrewal. “And then how do we prevent it happening? That is the next stage.”
