Document Type

Article

Publication Date

8-17-2026

Comments

This article is the author’s final published version in Journal of Experimental Orthopaedics, Volume 13, Issue 3, 2026, Article number e70888.

The published version is available at https://doi.org/10.1002/jeo2.70888. Copyright © 2026 The Author(s).

 

Abstract

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.

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This work is licensed under a Creative Commons Attribution 4.0 License.

Language

English

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