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With the new Premiership season underway, we ask why more players than usual have started it on the treatment table.

Last season, 28 Premiership players needed the help of a knee consultant following severe knee ligament damage. That was the highest figure in five years. Of those, 17 suffered anterior cruciate ligament (ACL) damage, the highest tally in Premier League history, with notable victims including Man Utd and Sweden striker Zlatan Ibrahimović and ex-Sunderland goalkeeper (and new Everton recruit) Jordan Pickford.

With clubs frequently fielding teams worth a combined total of hundreds of millions of pounds, a player spending nine months on the sidelines is something few can afford. According to research by insurance broker and risk consultant JLT Specialty, injured Premier League players were paid £177 million by their clubs last season with knees second only to hamstrings in the injury league table.

Chelsea, Premier League champions, suffered 21 casualties (knee injuries included) costing £6.6 million in salaries. Relegated Sunderland had 58 injuries at a cost of £11.65m. There isn’t a strong correlation in salary costs compared to league positions (Middlesbrough went down despite a relatively modest injury wage bill) but it doesn’t take a football pundit to spot that having your best players in the hands of the knee doctor rather than the coach is not a great recipe for league success. With so many key players out of action for prolonged periods, it was arguably the deciding factor in Manchester City’s failure to challenge for the title.

Getting to the root of knee injuries in football, therefore, has ramifications for players, results and team finances.

>  Discover more about sports knee injuries

Yet the increase in the requirement for knee surgery is not being felt purely at Premiership level. All leagues – professional and amateur – are experiencing an upturn in the frequency of players requiring knee treatment.


The smoking gun?

Given that the increase in ACL injuries affects all levels of football, the reason has to be down to factors affecting all levels of the game, with the following frequently suggested as candidates:

  • Too many games? This argument really doesn’t hold water. Whilst some injured players’ seasons will have amounted to 50+ games, many more won’t – a product of variable league sizes, varying cup run successes and the absence or otherwise of European football.
  • Age: Age may be an issue in specific cases – Zlatan Ibrahimović is 35. Yet player conditioning has arguably never been better in the professional leagues, and injuries appear to be spread across age groups.
  • Pitches: Is the increased need to call on knee specialists a product of new-style pitches? Here again, there’s a wide disparity between leagues. Some amateur teams may continue to operate on something akin to ploughed fields, but clubs beneath the Football League have increasingly been investing in third generation artificial pitches. Top teams, in contrast, continue to use turf pitches interwoven with synthetic fabrics to prevent the turf from ‘cutting up’.Whilst individual injuries could be a product of too firm a pitch, or turf slippage, there again appears too little consistency across leagues to point the finger at pitches alone.
  • The speed of the game? Football has got faster, increasing the likelihood that damage resulting from an ill-timed tackle will be greater. Yet as football pundit and former player Pat Nevin told the BBC, his main concern was the ACL injuries occurring for reasons other than tackles.
  • Boots? Boots have become softer and less supportive, favouring ball control over foot protection. Inevitably, as the stability of the foot is reduced, the risk of needing the services of a knee consultant is increased. Boots are also the only factor common to every level of the game. Even Sunday morning part-timers will play in advanced footwear, even if it isn’t quite as advanced as that worn by Premier League stars.

Boots, on the face of it, are the answer. But this may be an oversimplification. For many in the game, the increase in ACL injuries is not attributable to one factor, and is instead a product of numerous elements which vary from club to club, yet in each produce similar outcomes. At a Premiership Club, factors may include footwear, number and frequency of games played, game speed and hard pitches. At a lower level, the toxic combination may involve footwear, age, conditioning and artificial or poor turf pitches. The demands of the modern game may mean that it is players’ knees that continue to bear the brunt, with no clear cause found. As Leicester City’s grounds manager John Ledwidge told the BBC, “everything is a contributing factor when it comes to players.”


Yorkshire Knee Clinic provides knee consultancy for footballers of all levels, from amateur to elite. For help in addressing your knee pain, talk to Yorkshire Knee Clinic now.

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