Ted Lasso is back on our screens, and this time he is not managing AFC Richmond’s men’s side. Season four sees the relentlessly optimistic coach take charge of the club’s newly formed women’s team, the Lady Greyhounds, a storyline that mirrors the real momentum currently building behind women’s football.
The storyline carries extra weight given Arsenal and England captain Leah Williamson worked as an authenticity consultant on the new season, and one of the show’s central new characters, assistant coach Alice Chilton, is a former player whose career was ended by three separate ACL tears.
As the sport continues to grow in profile, so does scrutiny of an issue that has followed it for years: why female footballers are so much more likely to suffer an ACL injury than their male counterparts, and why, for many, the risk does not end after their first reconstruction.
A familiar story in women’s football
We explored some of this territory in our earlier piece on Leah Williamson’s conversations around ACL injuries, where the England captain spoke candidly about how common the injury is in the women’s game and the importance of proper preparation from a young age.
The anterior cruciate ligament sits deep within the knee, connecting the thigh bone to the shin bone and helping to keep the joint stable during twisting and pivoting movements. It is one of the most commonly injured ligaments in football, and usually tears through a sudden change of direction or landing rather than a direct collision.
A recent review from the American Orthopaedic Society for Sports Medicine put real numbers behind what Williamson described. It found that female athletes are between two and eight times more likely to suffer an ACL injury than male athletes, and that once a woman has had ACL surgery, she faces around four times the risk of injuring that same knee again and six times the risk of injuring the other one, compared with men. Since then, further research has continued to build a clearer picture of what is really driving this disparity.
Why the risk does not stop at the first ACL injury
Recent work has focused not just on why women sustain ACL injuries more often, but on why they are also more likely to injure the same or opposite knee again after surgery. A 2026 review of ACL injury in female footballers found that generalised joint hypermobility and excessive knee hyperextension are significant predictors of a second ACL injury in women who have already had a reconstruction, and argued that graft choice should be tailored individually rather than following a one-size-fits-all approach.
A separate meta-analysis published this year, examining return-to-sport outcomes specifically in female athletes, reinforced how much more complex this picture is for women, both in how many return to competitive sport and how long that takes. Alongside the physical factors, psychological readiness is increasingly recognised as central. Fear of re-injury remains one of the most commonly cited reasons athletes, particularly women, do not return to their pre-injury level of sport, regardless of how well the knee has healed physically.
What this means for ACL injury treatment
Taken together, the evidence points to a simple conclusion: female athletes recovering from ACL injury need a plan that accounts for their individual biomechanics, hormonal factors, and psychological readiness, not a standard protocol. This matters even more when a second injury occurs, where graft selection, tunnel positioning, and rehabilitation timelines all carry greater weight than they did the first time round.
Mr Shah Punwar has extensive experience in both primary ACL reconstruction and the more complex field of revision ACL surgery, working with athletes at all levels to plan treatment around their individual risk profile rather than a generic approach. For female athletes in particular, this individualised assessment can make a meaningful difference to both the success of surgery and the confidence with which they return to sport.
If you have experienced an ACL injury, whether for the first time or as a repeat injury, a specialist assessment with Mr Punwar can help determine the most appropriate course of action.
Book a consultation with Mr Shah Punwar today by calling 020 8194 8541.
