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In the Premier League, the ACL epidemic is why

Jurrien Timber suffered an ACL injury on his Premier League debut for Arsenal. Credit: Getty Images/David Price

In normal times, the news that Chelsea midfielder Karni Chukwuemeke will need knee surgery this week could be a source of great concern. After all, Chukwuemeka is only 19 years old. But these are not normal times in elite football, and the absence of a midfielder for about six weeks instead seems like an occasion for light relief.

No matter how strange it may be. Sound, Chukwuemeka is one of the lucky ones. In recent weeks, an extremely large number of top players across Europe have been less fortunate. The list of stars who have suffered serious knee injuries since the start of pre-season is unusually – and alarmingly – long. Chukwuemeka was out of the game for six weeks after knee surgery. Photo: Sportimage/Paul Terry

The team has already had two ACL injuries at Aston Villa (Amy Buendia and Tyrone Mings). Real Madrid also had two cruciate ligament injuries (Thibaut Courtois and Eder Militao). Arsenal's Jurrien Timber also suffered an ACL injury, as did Chelsea's Wesley Fofana. Monaco's Brel Embolo suffered a torn ACL earlier this month, and former Manchester City midfielder David Silva retired with a cruciate ligament injury of his own.

Ben Dinnery's analysis from Premier Injuries shows that there were only four ACL injuries in the entire 2022/23 season in the Premier League, and only five in the previous season. This time, including the pre-season, there were already four.

The problem is not limited to ACLs. Chelsea's Christopher Nkunku, who came from RB Leipzig for £52m, has been ruled out until December after undergoing surgery for a knee injury he suffered in pre-season. Arsenal's Gabriel Jesus also underwent knee surgery, although he is expected to be out for weeks rather than months. Kevin De Bruyne has been out for several months after undergoing hamstring surgery.

It is generally accepted in the game that serious injuries are more likely at this time of the season than at any other point in the campaign. This is largely due to the sudden increase in intensity at the beginning of competitive activities.

But to see so many problems so early in the season is certainly strange. Telegraph Sport spoke to a Premier League club physiotherapist who was overwhelmed by the sheer number of serious injuries, especially to the knees.

What happens then? According to some coaches, including Pep Guardiola and Mikel Arteta, these problems are the result of a huge physical load on the players. “Look how many ACLs are here,” Guardiola said last week. «They make you go to Asia, to the United States, there are really hard matches, derbies, big games, and people fall and they will fall and fall because the show must go on.»

Asked last week about the spike in serious injuries, Arteta said: “There is something about it. Games, plus tours, plus the World Championship in December, plus international tournaments — that's a lot. It's too much for the players. It's incredibly demanding. When you see these players' calendar for the next 36 months, it's best not to look at it, because it's incredible what they'll have to do.»

Tyrone Mings required knee surgery after suffering an injury during Aston Villa's game against Newcastle United. Credit: PA/Owen Humphreys

Maheta Molango, Executive Director of the Professional Football Players Association, said that the «number one topic» in his meetings with players and managers is injury prevention and protection against burnout.

“The rise in player injuries is a natural consequence of an increasingly busy football calendar that shows no signs of slowing down. Players feel pushed to the limit, one season flows into the next,” Molango told Telegraph Sport.

“They say sometimes they feel like they're just focusing on getting through the game. by game. They do not have time to fully recover, they are constantly tired or injured. This situation is simply unsustainable.”

In particular, when it comes to anterior cruciate ligament injuries, the situation is not simple. According to Consultant Knee Surgery Saket Tibrewal, more research is needed in the sports world to fully understand the cause of such severe knee problems, which are even more common in women's games.

«As far as we know, cruciate ligament injuries on not really related to fatigue,” Tibrewal said. “More injuries happen in the first half of matches than in the second, which doesn’t fit into that theory. We have a National Bundle Registry and we collect data to identify trends. We'll have a better idea in the future.»

Of course there are theories. Firstly, this hotter time of the year results in harder pitches, which can play a role as a harder surface results in more force transmitted through the leg.

There are also risk factors – “anterior cruciate injury ligaments.» on one leg increases the risk of a second anterior cruciate ligament injury on the other,” Tibrewal said, as well as other possible explanations. One of them, as unpleasant as it may be, is a coincidence. «Maybe it's just bad luck,» Tibrewal said.

Work is underway to find solutions and hopefully find a way to better protect football players from these injuries. However, for those who are already in treatment, it is already too late, and players fear that such a series of injuries is a worrying sign of what lies ahead for us this season.

«How do we predict who is what will happen , is the most difficult moment,” Tibrewal said. “Then how can we prevent it? This is the next stage.

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