Arsenal at forefront of ACL epidemic as Pelova injury offers worrying reminder (2024)

For many Arsenal fans, the sight of midfielder Victoria Pelova limping off 12 minutes into the Netherlands' clash with Finland last week will have stirred a familiar sense of unease.

The 25-year-old was substituted after a fairly innocuous coming together with Finland defender Emma Koivisto and, though she was able to leave the pitch unaided, it was impossible not to fear for the worst. It was, then, not a surprise to see those fears realised on Wednesday morning, when Arsenal released a statement confirming Pelova had ruptured her anterior cruciate ligament (ACL).

This is painfully familiar territory for the Gunners, who have now seen seven of their players sustain the devastating knee injury since the start of 2022. Beth Mead, Vivianne Miedema, Leah Williamson, Laura Wienroither and Kaylan Marckese have all suffered the same dismal fate over the course of the past two years, with defender Teyah Goldie having ruptured both her left and right ACL in that timeframe.

Pelova now finds herself a reluctant member of that dreaded club and will undergo surgery in due course, before embarking on a grueling rehabilitation journey that could deprive her of more than a year of her professional career. For Arsenal, it is a huge blow.

The Netherlands international, who joined the club from Ajax in January 2023, has been one of their standout performers this season. She is the Gunners' top assister in the WSL and is second only to Alessia Russo for the amount of minutes played in all competitions.

But, while Pelova's protracted absence poses Arsenal with a logistical headache ahead of the summer transfer window, it also offers another troubling reminder of an issue that is rapidly becoming endemic in the women's game. Research suggests female footballers are between two and six times more likely to suffer ACL injuries than their male counterparts, with about two-thirds of those injuries occurring when there is no physical contact.

READ MORE: When does the 2024 summer transfer window open and close? Premier League, EFL and WSL dates

READ MORE: Arsenal defender Laura Wienroither signs new deal after return from ACL injury

That between 25 and 30 players, including England's Mead and Willamson, missed the Women's World Cup last summer because of ACL tears is proof enough of the scale of the crisis. Studies also show that women are 25% less likely to make a full recovery and return to the pitch than men, though it is currently impossible to pinpoint one definitive cause behind these worrying statistics.

Anatomical differences in women and fluctuating hormones during menstrual cycles have been put forward as variable factors, while some researchers advocate for the significance of female footballers playing in boots designed for men. A 2023 report commissioned by the European Club Association revealed as many as 82 per cent of female players surveyed experience high levels of discomfort wearing football boots, with companies like Nike now beginning to design boots specifically tailored for women.

Then there is the school of thought that the increasingly congested nature of the women's football calendar is chiefly responsible for this deluge of ACL injuries. Speaking to the Telegraph in January, Arsenal defender Williamson said: "We’re not bred for this. Nowadays we get to October and girls are saying, “I’m tired” because you’re carrying so much from the previous season.’

"‘Ultimately, I think the way you’re taking women’s football right now, you won’t be able to increase the ticket prices or get bigger crowds in the stadiums because you won’t have players to watch. We are driving ourselves into the ground with it, so some sort of solution needs to be found soon, in terms of the schedule, otherwise it’s not sustainable."

There will, of course, be those who argue that the decision-makers at big clubs like Arsenal further exacerbate those issues around sustainability. For example, there was a public outcry when the Gunners announced that a number of their players - including Pelova - would be travelling to Australia for a post-season exhibition game in Melbourne last month.

Pelova played 45 minutes of the 1-0 victory over the A-League All Stars, which took place less than a week after the end of the WSL season, before jetting back to Europe where she linked up with her national team for their UEFA EURO 2025 qualifiers. The impact of jetting across the globe, with minimal rest time, before training and playing at a variety of different venues is something departing Chelsea boss Emma Hayes raised back in February, after losing both talisman Sam Kerr and fellow striker Mia Fishel to ACL injuries.

"It's not as simple as saying that different teams have a different training load or travelling schedule, or recoveries, etc. We need to really reflect on what we do," Hayes said. "If you want to do a piece of research, go back through all those major injuries and how quickly they coincided with big changes, combined with menstrual stuff, training, pitches etc. That's just my opinion. There's a lot of work still to do."

The severity of women's football's ACL epidemic is such that some players have taken it upon themselves to highlight the need for more research. After rupturing their ACLs within a month of each other in 2022, Arsenal duo Mead and Miedema teamed up to create a documentary titled "Step-by-Step", charting their respective recovery journeys and showcasing the mental and physical toll the injury can have on an affected player.

"Someone has got to be very rich to figure out how to stop these injuries," Mead told BBC Sport earlier this year. "There's no definitive answer on how to stop it and I think that's the frustrating part. We do feel the responsibility. There's a lot of us that have power in a good way to try to help and push on with the research."

Fortunately, the groundswell of demand for more research is now finally starting to bear fruit. In December, UEFA announced the introduction of an expert panel on women's health to seek a deeper understanding of ACL injuries and their prevalence among female players.

Four months later, FIFPro, the Professional Footballers Association (PFA), Nike, and Leeds Beckett University joined forces to launch 'Project ACL' - a research initiative aimed at reducing ACL injuries in women’s football.

The three-year project will focus on players in the WSL, evaluating their current working environment and monitoring individual workloads in real-time. "We need to start fine-tuning the information that we're putting out," Barcelona and England defender Lucy Bronze said after the project was unveiled. "There is already research, but I think there's just so much talk and a lot of wrong information out there.

"There isn't a quick fix to eradicate ACL injuries in women's football; we need to finely tune research so that we can identify the key factors. A lot of players need to be more aware on the process of why ACL injuries happen and what can be done to reduce the risk.

"Just changing football boots is not going to fix anything. There are many things that can be done and it's important that the right information is available for players, their support systems, clubs and for the game in general."

Bronze is right to urge caution. For an issue as widespread and far-reaching as this one, there is no simple solution and it will likely take several years before the necessary measures are taken to minimise the frequency of ACL injuries in the women's game.

But initiatives like UEFA's and Project ACL are, at least, a step in the right direction - a step that, for clubs like Arsenal, can not come soon enough.