Two‐thirds return but performance suffers: ACL reconstruction outcomes across elite European women's soccer leagues
Haneef Khan, Forest Rodriguez, Amina Khan, Ashley Rosenberg, Stephen MarcaccioAbstract
Purpose
To analyse return‐to‐play (RTP) rates, timing and performance outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR) in elite European women's soccer players across the top five leagues.
Methods
We reviewed ACL injuries sustained by female professional soccer players across the Bundesliga, Women's Super League, Primera División Femenina, Serie A Women and Première Ligue between 2007 and 2025. Players were included if they had a confirmed ACL injury requiring ACLR and one season of performance data pre‐ and post‐injury. Players were excluded if the injury occurred during their rookie season or after the 2023 season. Data were collected from Soccerdonna.de and Transfermarkt.
Results
A total of 242 ACL injuries in 206 unique players were included, with a median follow‐up of 2.0 seasons (interquartile range [IQR]: 1.0–4.0). The cohort had a median age at injury of 22.7 years (IQR: 20.4–26.0; mean 23.4 ± 3.8 years). Of 242 injuries, 161 (66.8%) resulted in RTP. For those who returned, the median RTP time was 9.8 months (IQR: 7.9–11.4). Only 7 (5.1%) players achieved RTP before 6 months. In the first year following RTP, significant performance decreases were observed: games played (−47.4%, p < 0.001), total minutes (−57.8%, p < 0.001) and minutes per game (−24.4%, p < 0.001). Midfielders experienced the greatest decline in playing time (−41.2%, p < 0.001), while goalkeepers showed minimal change (−8.0%, p = 0.625). No significant age‐related differences were observed. Median post‐injury career length was 2.0 seasons (IQR: 2.0–4.0).
Conclusions
A RTP rate of 66.8% was observed following ACLR in elite European women's soccer; however, returning players faced significant performance decreases in the first year post‐return, with notable position‐specific variations. These reductions likely reflect a combination of injury‐related recovery factors and team selection dynamics. Rehabilitation and RTP strategies should therefore integrate position‐specific demands, realistic performance expectations and gradual reintegration plans, particularly for midfielders who demonstrated the greatest performance decline.
Level of Evidence
Level III.