Playing the field: A retrospective analysis of anterior cruciate ligament injuries and playing position in elite female football (soccer) players

Female football (soccer) athletes occupy different playing positions of goalkeeper, defender, midfielder, and forward that may influence ACL injury risk. This study examined the relationship between ACL injury and playing position in elite female footballers, and analysed player age, injury duration and injury seasonal timing with playing position subgroup analysis. Retrospective observational study using third party collected data from public multimedia confirmed elite female football player ACL injuries from 01/01/2022-31/12/2024. Public databases confirmed playing position, age, playing league, injury date and return to competition date. Season injury timing was calculated using league schedule data. De-identified records were analysed; Categorical variables were reported as frequencies and percentages, analysed using Chi-Square tests. Continuous variables were reported as medians and interquartile ranges, analysed using Kruskal-Wallis tests. From 541 total ACL-injuries, midfielders were most frequently injured (n = 183, 33.8%), then defenders (n = 169, 31.2%), then forwards (n = 149, 27.5%) with no significant difference in frequency of injury (χ2 = 3.497, df = 2, p = 0.174). Goalkeepers were least frequently injured (n = 40, 7.4%). ACL injuries were significantly increased in the first (n = 74, |Z| = 5.05, p < 0.001) and second (n = 69, |Z| = 4.27, p < 0.001) months of the playing seasons. All outfield playing positions confer similar ACL injury risk in elite female footballers. The lower goalkeeper ACL injury frequency likely reflects less goalkeepers in the population with reduced cumulative match-play exposure. Playing position injury trends are similar to those observed in elite male football. A high-risk window for ACL injury in the early competitive season is a novel finding for this cohort.