UEFA consensus guidelines on anterior cruciate ligament (ACL) injury in Women’s football – part one: risk factors and prevention

Anterior cruciate ligament (ACL) injuries are among the most burdensome injuries in women's football, carrying significant consequences for players and the football community. To develop practical, evidence-based guidelines for ACL injury prevention, UEFA convened a multidisciplinary expert panel of 31 doctors, sports scientists, physiotherapists, and a player. Using the RAND-UCLA Appropriateness Method, 101 evidence statements were synthesised from existing literature and subjected to a modified Delphi process with three rounds of confidential voting. Consensus was reached on 88 statements. Through online and in-person discussions, this evidence was integrated with expert and clinical and practical judgement to produce actionable recommendations tailored to women's football. The guidelines conclude that ACL injuries in women's football typically occur in non-contact situations during high-intensity movements such as cutting, pressing, or landing, and may be influenced by a combination of modifiable and non-modifiable risk factors. Proposed modifiable factors include deficits in neuromuscular control, strength, and movement quality, which can be addressed through multicomponent prevention strategies. These programmes were identified as the most effective, incorporating plyometric, strength, and proximal control exercises performed two to three times per week for 15 to 20 minutes, with evidence showing they can reduce non-contact ACL injuries when adherence is high. Successful implementation requires context-specific tailoring, embedding programmes into routine training, and addressing barriers such as limited resources, time constraints, and lack of coach education. The guidelines recommend enhancing buy-in through co-creation with coaches and players, integrating prevention into existing practice, and strengthening organisational and policy support to sustain long-term adoption.

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Publication Details

Journal
Science and Medicine in Football
Published
2026-10-14
DOI
https://doi.org/10.1080/24733938.2026.2747391
Primary Topic
Knee injuries and reconstruction techniques
Type
article
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article

UEFA consensus guidelines on anterior cruciate ligament (ACL) injury in Women’s football – part one: risk factors and prevention

Celeste Geertsema, Javier Yanguas, Lawrence Mayhew, Sebastian Rilk et al.
Science and Medicine in Football
Knee injuries and reconstruction techniques
article

UEFA consensus guidelines on anterior cruciate ligament (ACL) injury in Women’s football – part one: risk factors and prevention

Celeste Geertsema, Javier Yanguas, Lawrence Mayhew, Sebastian Rilk, Christina Y. Le, Meredith Chaput, Matthew Whalan, Chris Brogden, Amelia Joanna Hanford Arundale, Zoran Bahtijarević, Grethe Myklebust, Jelle P. van der List, Stephanie Rose Filbay, X. Linde, Ventura Ferrer-Roca, Evert A.L.M. Verhagen, Eva Ferrer, Naomi Datson, Gino M. M. J. Kerkhoffs, Martin Hägglund, Allison M. Ezzat, Tania Nilsson, Christian Moen, Carly D. McKay, Katrine Okholm Kryger, Gary Lewin, Elke Van Den Steen, Gabriel Monthuley, Frank Barnett
article en

Abstract

Anterior cruciate ligament (ACL) injuries are among the most burdensome injuries in women's football, carrying significant consequences for players and the football community. To develop practical, evidence-based guidelines for ACL injury prevention, UEFA convened a multidisciplinary expert panel of 31 doctors, sports scientists, physiotherapists, and a player. Using the RAND-UCLA Appropriateness Method, 101 evidence statements were synthesised from existing literature and subjected to a modified Delphi process with three rounds of confidential voting. Consensus was reached on 88 statements. Through online and in-person discussions, this evidence was integrated with expert and clinical and practical judgement to produce actionable recommendations tailored to women's football. The guidelines conclude that ACL injuries in women's football typically occur in non-contact situations during high-intensity movements such as cutting, pressing, or landing, and may be influenced by a combination of modifiable and non-modifiable risk factors. Proposed modifiable factors include deficits in neuromuscular control, strength, and movement quality, which can be addressed through multicomponent prevention strategies. These programmes were identified as the most effective, incorporating plyometric, strength, and proximal control exercises performed two to three times per week for 15 to 20 minutes, with evidence showing they can reduce non-contact ACL injuries when adherence is high. Successful implementation requires context-specific tailoring, embedding programmes into routine training, and addressing barriers such as limited resources, time constraints, and lack of coach education. The guidelines recommend enhancing buy-in through co-creation with coaches and players, integrating prevention into existing practice, and strengthening organisational and policy support to sustain long-term adoption.

Science and Medicine in Football
Linköping University (SE), University of Central Florida (US), Manchester Metropolitan University (GB), Hospital for Special Surgery (US), Mount Sinai Health System (US), University of British Columbia (CA), The University of Melbourne (AU), University of Calgary (CA), La Trobe University (AU), St Mary's University Twickenham London (GB), The Ohio State University Wexner Medical Center (US), Qatar Orthopaedic and Sports Medicine Hospital (QA), AZ Sint-Jan (BE), FC Barcelona (ES), HolsboerMaschmeyer NeuroChemie (Germany) (DE), Amsterdam University Medical Centers (NL), Manchester City Football Club (GB), Federação Portuguesa de Futebol (PT), University of Bath (GB), Universitat de Barcelona (ES), Medical University of Vienna (AT), Leeds Beckett University (GB), Vrije Universiteit Amsterdam (NL), University of Gothenburg (SE), Saarland University (DE), Icahn School of Medicine at Mount Sinai (US)
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Knee injuries and reconstruction techniques
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