Chloe Kelly overcame a major ACL injury to score the winner in this summer’s Euros. She overcame something else too: what she described as the crushing “negativity” around her ACL injury that saw her struggling mentally during her recovery. Nick London shares his take on Chloe’s situation.

On 31 July, Chloe Kelly did what decades of English footballers had been unable to do since the days of Geoff Hurst: she scored the winner in the final of a major football tournament. Against the Germans, no less. At long last, and at the risk of causing you to wince, football came home.

Not so long before, Chloe probably felt she was an unlikely candidate to even make it onto the pitch for the final, let alone poke home the winner. Playing for her home club Man City during the 2020/21 season, she had been bearing down on Birmingham City’s goal when a collision with their centre-back Rebecca Holloway resulted in an ACL rupture that saw her miss out on the Tokyo Olympics and remain out of action for 11 months.

We’ve known for at least 15 years that females are at much greater risk of ACL injuries than males. The issue is multifactorial: part hormonal, part physiological and, perhaps most notably, part biomechanical. How women move, jump, twist and turn, in combination with other factors, seems to put them at greater risk of ACL rupture than men.

Increasing awareness, increasing prevention

As female participation in football has grown, so the number of ACL injuries has increased. If, as many predict, the Lionesses’ victory triggers an explosion in the number of girls wanting to play football, we risk seeing many more such injuries. That’s why we need to be ahead of the game, ensuring clubs and players are aware of the increased risk and have prevention programmes in place not just at professional levels but amateur ones too.

The research we’re currently doing at Leeds Beckett University into injury prevention at school age is examining the broad range of factors that contribute to the high incidence of ligament injuries. It is also helping us develop programmes to optimise movement patterns, so in future we can minimise ligament damage in all players.

> Discover more about female ACL injuries

Addressing the negativity

Yet reducing the incidences of injury is only part of the story. As Chloe Kelly told the BBC, she feels the narrative around ACL injuries affected her mental health and needs to change.

“Why does everyone fear it so much? Why is it when someone has done their ACL, there’s just negativity that goes with it? We put nine to 12 months on it as soon as it comes,” she said.

“I think the negativity around ACLs, more than the research, is something that I would like changing. Going through rehabilitation when there is so much noise around how bad it is, probably makes it worse. Any injury is difficult.”

Speaking about the post-injury period, Chloe told the Manchester City website, “You feel worthless in those moments. I didn’t think I could overcome it but it’s about having good people around you.”

As a knee surgeon who’s been treating ACL tears for decades, I find it worrying that she felt this. With such high success rates for reconstruction and such a well-trodden path to recovery there no longer needs to be the same level of doom-mongering surrounding ACL injuries as was common in the 1970s and 80s. Around 90% of professional athletes suffering ACL injuries now return to sport post-injury. Around 80% return to the same level of sport.

An ACL tear is a serious injury, and it can still be a ‘career threatener’ for an unfortunate few, but so can lots of other injuries and they don’t have the same grim PR of ACL tears.

Chloe Kelly is right. ACL injuries are to be accepted just as other common injuries are. Clinicians, coaches and fellow players need to understand the impact of their words and ensure the mental as well as physical needs of the players are supported through recovery and reintegration.

Because as Chloe has demonstrated, an old ACL injury is no barrier to winning sport’s most prestigious trophies.

If you are concerned about your ACL injury, contact us or phone us on 03453 052 579.

> Discover more about Nick London
> Discover more about female ACL injuries
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