Uefa consensus guidelines on anterior cruciate ligament (ACL) injury in women's football - Part Two: rehabilitation, return to play, and players' perceptions.

Abstract

Anterior cruciate ligament (ACL) injuries remain a major challenge to player health and performance in women's football. They are associated with lengthy rehabilitation, a high risk of re-injury, and potential long-term knee issues that can impact both career longevity and quality of life. Building on Part One of the UEFA consensus, which addressed risk factors and prevention, Part Two addresses the continuum of care after ACL injury, from rehabilitation to return to play (RTP) and beyond. A multidisciplinary panel of 26 experts in sports medicine, physiotherapy, orthopaedics, and performance science developed evidence-informed statements using a modified RAND-UCLA Appropriateness Method. Through three Delphi rounds, 180 statements were assessed and refined, resulting in consensus on 170 (94%). The panel supported a player-centred, criterion-based approach where progression relies on clinical and functional milestones rather than fixed timelines. Key recommendations emphasise restoring quadriceps strength as a central milestone, integrating neuromuscular and psychological readiness assessments, and adopting phased RTP protocols that gradually re-expose players to the physical and cognitive demands of the game. Psychological and social factors (fear of re-injury, motivation, communication, and support networks) are recognised as vital influences on recovery. These guidelines offer practical, evidence-based advice for medical and performance staff working in women's football. By combining scientific research with expert consensus, they support a holistic, collaborative approach to ACL rehabilitation aimed at protecting player health, lowering re-injury risk, and enabling a confident, sustained return to performance.