Related Experiment Video
Updated: Aug 19, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Two-thirds return but performance suffers: ACL reconstruction outcomes across elite European women's soccer leagues
Haneef Khan1, Forest Rodriguez2,3, Amina Khan4
1University of Michigan Ann Arbor Michigan USA.
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.