The anterior cruciate ligament (ACL) injury ‘Epidemic’: A perfect storm for Post-Traumatic Osteoarthritis

Anterior cruciate ligament (ACL) injuries are increasingly common, particularly among women and adolescents participating in high-intensity, multidirectional sports. Despite being a small ligament, the ACL has a disproportionately large impact on an individual's physical and psychological well-being and has gained significant media attention. Female athletes face a higher risk of ACL injury than their male counterparts, due to a complex interaction of anatomical, hormonal, and social factors. With rising rates of injury, particularly in younger populations, there is growing concern about the long-term consequences, most notably, the development of post-traumatic osteoarthritis (PTOA). Current treatment pathways do not eliminate this risk, and within 15 years, radiographic evidence of OA is found in up to 41% of those affected. This article highlights the pressing need for targeted prevention strategies, enhanced rehabilitation, and long-term joint preservation. It highlights the role of injury prevention programmes, precision health, and emerging regenerative therapies in tackling the burden of ACL injuries. Greater investment in sex-specific research is needed to protect future generations of athletes. Collaboration between healthcare professionals, researchers, policymakers, and patients is essential to reduce the physical, psychological, and economic toll of ACL injuries across the population.