UEFA consensus guidelines on anterior cruciate ligament (ACL) injury in Women’s football – part one: risk factors and prevention

Anterior cruciate ligament (ACL) injuries are among the most burdensome injuries in women's football, carrying significant consequences for players and the football community. To develop practical, evidence-based guidelines for ACL injury prevention, UEFA convened a multidisciplinary expert panel of 31 doctors, sports scientists, physiotherapists, and a player. Using the RAND-UCLA Appropriateness Method, 101 evidence statements were synthesised from existing literature and subjected to a modified Delphi process with three rounds of confidential voting. Consensus was reached on 88 statements. Through online and in-person discussions, this evidence was integrated with expert and clinical and practical judgement to produce actionable recommendations tailored to women's football. The guidelines conclude that ACL injuries in women's football typically occur in non-contact situations during high-intensity movements such as cutting, pressing, or landing, and may be influenced by a combination of modifiable and non-modifiable risk factors. Proposed modifiable factors include deficits in neuromuscular control, strength, and movement quality, which can be addressed through multicomponent prevention strategies. These programmes were identified as the most effective, incorporating plyometric, strength, and proximal control exercises performed two to three times per week for 15 to 20 minutes, with evidence showing they can reduce non-contact ACL injuries when adherence is high. Successful implementation requires context-specific tailoring, embedding programmes into routine training, and addressing barriers such as limited resources, time constraints, and lack of coach education. The guidelines recommend enhancing buy-in through co-creation with coaches and players, integrating prevention into existing practice, and strengthening organisational and policy support to sustain long-term adoption.