'ACL epidemic in women's football': the epidemiological evidence does not support the narrative

Media narratives commonly portray elite women's football as experiencing an 'ACL epidemic', suggesting a sharp and alarming rise in ACL injuries. Such claims warrant scrutiny as they may influence perceptions of women's sport. This paper combines published injury surveillance data over the past 25 years to observe trends in ACL injury incidence and volume in elite women's football. Data were extracted from 10 peer-reviewed studies identified through recent systematic reviews and targeted searches, covering top leagues in six countries and UEFA competitions. ACL injury incidence rate in training, match play and overall, as well as the number of injuries per team per season, were examined across leagues and time periods. Despite limitations in geographical coverage and gaps in longitudinal data, findings consistently demonstrate low stable ACL injury incidence rates, with fewer than one ACL injury per team per season in almost all studies. Notably, some of the lowest match incidence rates were reported in the most recent seasons. Overall, the available evidence does not support the notion of an ACL injury 'epidemic' in elite women's football with similar trends of <1 ACL injury in all studies collected apart from one study assessing the German league 2003-2004 season with 1.2 ACL injuries per team per season. This highlights the need for evidence-based, non-sensationalist discourse.