ACL injury timing during matches in professional women's football: A 208-case analysis from the 2022–2024 seasons

Objectives: This study aimed to analyse the timing of ACL injuries during match play in professional women's football games. Design: Media-based retrospective cross-sectional study. Methods: Retrospective analysis of playing time associated with ACL injuries across international competitions and 27 professional leagues between 2022 and 2024. Identification of ACL injuries involved media reports, including online searches for official statements and interviews. Follow-up verification of time within gameplay, including video and substitution minutes, was also conducted. Kaplan–Meier survival analysis assessed the ACL injury risk over playing time; injuries pre vs post 45 min were compared using a one-sample proportion test with continuity correction. Results: Of the 208 ACL injuries captured during an official match, the majority (70 %) occurred within the initial 45 min of play (p < 0.001), with 50 % of injuries within the first 28 min. Survival analysis revealed a declining risk of ACL injury as the game continued, resulting in only a 25 % likelihood of injury occurring in the last 40 min of the game. Conclusions: Most ACL injuries in women's football occurred within the initial 45 min of effective playing time, particularly between the 15th and 35th minutes. This suggests that early-game intensity, acute fatigue or other factors rather than cumulative fatigue may contribute to ACL injury risk.