ACL Injuries Explained: Causes, Risks, and Why Recovery Takes So Long
- Think Football Ideas
- Aug 12
- 4 min read
The ACL Injury Breakdown: Why It Happens, How It Heals, and the Long Road Back
We often rave about the artistry of footballers’ footwork, the precision of a midfielder’s pass, or the lightning pace of a winger sprinting down the flank. Yet, the entire spectacle can be brought to a halt by a ligament no thicker than a pencil.
That’s the cruel reality of an ACL injury, a setback that can sideline even the fittest athlete for months on end. With James Maddison and Levi Colwill both sidelined by ACL tears before the 2025–26 season even begins, and names like Virgil van Dijk, Tyrone Mings and Rodri also struck down in recent years, it’s clear this is one of sport’s most feared injuries.
But why does it take so long to recover, and what actually makes the ACL so important?
1. Understanding the ACL: Anatomy and Function
The anterior cruciate ligament (ACL) is a crucial band of tissue that stretches diagonally through the inside of the knee, helping to keep it stable. It connects the thighbone (femur) to the shinbone (tibia) and keeps the joint stable, especially during twisting or pivoting movements.
Without it, the knee becomes vulnerable to slipping or giving way during sharp changes in direction. It truly is a nightmare scenario for footballers or any athlete.
Virgil van Dijk, who suffered an anterior cruciate ligament (ACL) injury in the Merseyside derby against Everton on October 17, 2020, spoke about this to Gary Neville on the Overlap Podcast.
He said: “I went down, and I always feel when I go down, I have to get up. I have to feel, I get knocks all the time, but I feel that if I’m standing up, I feel that I’m fine.
“I stood up and I walked and I felt the instability immediately. When I’m walking around the pitch, I had to go all the way to the corner of the (Googdison Park) stadium, ‘I’m thinking, what can this be? Is this it?’ As we are in the corner, I couldn’t walk anymore. I was limping.”
2. How ACL Injuries Happen
Most ACL tears occur in high-intensity sports when the foot is planted but the body changes direction abruptly. In football, that can mean a winger twisting past a defender or a defender stretching to block a pass.
It can also happen through awkward landings after a jump or from direct contact, like a heavy tackle. Rodri’s injury against Arsenal in September 2025 came from a sudden twist under pressure, a reminder that it doesn’t always require a bone-crunching challenge to do serious damage.
3. The Telltale Signs and Symptoms
A footballer or an athlete who tears their ACL often reports hearing or feeling a “pop” in the knee. Immediate swelling follows, sometimes within minutes, and bearing weight becomes difficult.
Instability is common as players describe the sensation as their knee “giving way” even during light movements.
4. Why ACL Tears Are A Big Deal
The ACL is central to controlled knee motion. Without it, high-level sport is nearly impossible. Beyond the immediate impact, missing months of competition, an ACL injury can reshape a player’s career.
Even after returning, some players struggle to regain their full agility or confidence, and there’s always the looming risk of arthritis in later years.
5. Diagnosis: From Pitch-Side to MRI Scans
On the field, medical staff can spot potential ACL damage through physical stability tests. However, confirming the injury usually involves an MRI scan, which shows whether the ligament is partially torn, completely ruptured, or accompanied by damage to surrounding structures like the meniscus.
6. Treatment Options: Surgery or Rehabilitation?
A complete ACL tear typically requires reconstructive surgery, especially for athletes aiming to return to professional competition. Surgeons replace the damaged ligament with a graft, often taken from the patient’s own hamstring or patellar tendon. In less severe cases, structured physiotherapy may be enough to restore stability.
7. Recovery Timeline and What to Expect
The road back from an ACL injury is long and demanding. The initial weeks focus on reducing swelling and regaining basic movement. From there, strengthening the muscles around the knee becomes the priority, followed by sport-specific drills.
For elite players or athletes, it can take anywhere from six to nine months and sometimes longer before returning to competitive action.
8. The Risk of Reinjury and Long-Term Complications
Unfortunately, one repaired ACL doesn’t mean the problem is solved forever. Returning too quickly or neglecting proper rehabilitation increases the chance of reinjury, either to the same knee or the other one.
Incomplete recovery can also accelerate wear and tear, leading to chronic knee pain or early-onset osteoarthritis.
9. Preventing ACL Injuries
Prevention focuses on building strength, balance, and proper movement patterns. Exercises that target the hamstrings, glutes, and core help stabilise the knee, while agility drills train the body to change direction safely.
Warm-ups that include dynamic stretching and neuromuscular training can reduce injury risk significantly.
10. Famous Cases and Lessons Learned
James Maddison and Levi Colwill’s recent setbacks serve as a warning that even peak-condition athletes aren’t immune.
Tyrone Mings and Virgil van Dijk’s recovery showed the resilience required to return, while Rodri’s absence in Manchester City’s run-in last season proved how a single injury can reshape a team’s ambitions.
These cases underline one truth: managing an ACL injury demands patience, discipline, and a long-term mindset.
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