ACL rupture is a troublesome injury for a footballer and the long-term consequences such as early-onset osteoarthritis is well known. Some studies reported the incidence of severe knee sprains involving ACL injury in football equal to 0.063 events per 1000 hours of exposure time. The ACL injury risk is higher, during the competition rather than in training. In the last two decades, the incidence of ACL injuries in girls has seen a major increase, with incidences increasing from 0.06 per 1000 hours to 0.1–0.2 per 1000 hours. Female footballers are reported to have a 2–6 times higher risk of ACL injury than males because of differences in anatomical and hormonal factors.

Indirect contact injuries are equally as prevalent as non-contact injuries in professional football. Most of the studies found, two-thirds of ACL injuries involved defending, while pressing or attempting to tackle. Existing literature also showed ACL injuries occurring generally in early knee flexion, with dynamic knee valgus loading. The higher proportion of ACL injuries occurred during the first part of the season with the secondary peak at late season compared to the midterm. The higher prevalence of ACL injuries in the first half suggests that accumulating fatigue throughout the match is not a key risk factor for injury. Four main situational patterns were found for ACL injury in football during video analysis: (1) pressing/tackling, (2) being tackled, (3) regaining balance after kicking and (4) landing from a jump.

Whereas operative treatment aims to reduce laxity, non-operative treatment aims to reduce functional instability and both thereby prevent further damage to the menisci and cartilage, which in turn may contribute to post-traumatic osteoarthritis. There is general consensus that both treatment options may be acceptable, depending on patient characteristics, including the type of sporting demands and the presence of concomitant injuries. In highly active sports like football which involves jumping, cutting and pivoting, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function may be recommended. Injury prevention programs that include plyometric exercises have a significant preventive effect against ACL injuries among both male and female footballers. The results suggested that ACL injury rates reduced by 60% in teams doing these specially designed prevention programs. After careful introduction of FIFA 11+ program, there was a significant reduction in the knee valgus angle at landing, which correlated with a significant decrease in ACL injury rate among female footballers. Improvements in movement biomechanics and knee joint stabilization are suggested to contribute to a reduction in injury risk.