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Keyhole surgery is perhaps a misleading term: despite the technology, expertise and extreme finesse involved, it’s also hugely physical. 

Sky News watches as surgeon Luke Jones performs an anterior cruciate ligament reconstruction in an operating theatre in King Edward VII’s hospital in central London.

Mr Jones (male surgeons are referred to as Mr rather than Dr) doesn’t just remove a hamstring: he pulls it out with force.

Drills bore through bone. Flesh smokes as it is cauterised. There’s a fair amount of hammering: “Mallet, please,” Mr Jones asks his assistant.

The ACL is a small band of tissue running through the middle of the knee that keeps it stable.

But watching the operation, it’s easy to understand why tearing it is so devastating. Even though the patient will only have three tiny scars, their knee has taken a pummelling.

“There’s 90 minutes in theatre with me,” Mr Jones tells Sky News, adding: “And then there is one year of rehabilitation with your physiotherapist afterwards.”

That’s why ACL injuries are so feared, especially by one type of athlete: female footballers.

‘Way too many’ women’s players with ACL injuries

Between 25 and 30 players – enough for an entire extra squad – will miss the upcoming World Cup because of ACL injuries. England stars Beth Mead and Leah Williamson have been ruled out. Data from ACL Women Football Club suggests 195 elite players have suffered the injury in the last year.

It has been described as an “epidemic”. And it is an epidemic that affects women far more than men: they are 2.5 to 3.5 times more likely to rupture an ACL than a male athlete. And we don’t really know why. Even as the women’s game has boomed, research has lagged behind.

One player who is going to the World Cup is England defender Jess Carter. Speaking before departure at St George’s Park, England’s national football centre, she tells Sky News: “There’s been way too many women’s players who have had ACL injuries and not enough research that’s been done about it.

“Why are there so many injuries? How can we prevent it? Why are they happening? A question I sometimes ask is: if this was happening to high profile men’s players, would more work be going in to try and improve things?”

England's Leah Williamson. Pic: AP
Image:
England’s Leah Williamson. Pic: AP

Nature versus nurture

The problem is that there isn’t just one answer.

“I’ve made a list the other day, and I think there are 30 reasons that have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher at St Mary’s University Twickenham and a medical researcher for FIFA.

“And I think we can split it into two main categories. And I like to call them nature and nurture.

“So the nature is like the biology: the genes, the way the body is shaped and muscle mass, etc… But also the nurture of the environment that the women are in. So the way that young female players are managed compared to male players, the facilities, the professionalism around the sport, the quality of the staff that they have available.”

I ask whether research into injuries in the women’s game has received as much attention as men’s.

“Attention? No. But generally that’s across all research in football and in sports medicine. The male has been the norm,” she adds.

Research will end up benefiting the men’s game too

Take one issue from the realm of ‘nurture’ that Kat is studying: football boots. The male foot was the norm. It’s only in recent years that boots designed specifically for women have become available. And even then we don’t understand the differences properly, which is why Kat has done 3D scans of hundreds of feet, to map them.

That research will end up benefiting the men’s game too because Kat is also charting the differences between ethnicities. Because the default foot isn’t just a man’s, it’s a white man’s.

The male is also the norm when it comes to other environmental factors, like booking a pitch.

On a Thursday evening in Kent, the Gravesham Girls and Women’s Football Club, founded in 1999, is training ahead of the start of the season. About 20 players, kitted out in yellow, are doing shooting drills and balls are flying. A Sky News camera operator cops one in the belly but bravely continues.

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Toni Allen and Keylie Oliver have both ruptured their ACL in the past. “I just screamed – everyone thought it was a fox,” Allen says. Both were out for a year.

“It’s quite daunting, and especially when you realise it’s not just football that it can impact, Oliver says.

“We have lives outside of football and it impacts that as well… At grass roots, the ladies always have a two o’clock kick-off. And that is because in our world, men’s football takes priority over women. We always have to play after – so the pitch is always ruined.”

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Women’s football: The ACL epidemic

The importance of the factors can change

Another difficulty is not just that there are lots of factors involved, it’s that the importance of the factors can change.

Professor Kirsty Elliott-Sale is professor of female Endocrinology and Exercise Physiology at the Manchester Met Institute of Sport.

She works closely with clubs, including Arsenal, to study how the menstrual cycle, or taking the Pill, can influence injuries. Research seems to suggest that some hormones can make ligaments looser, increasing the risk of rupture.

So over the course of the season Prof Elliott-Sale measures the laxity of players’ knees, charting that against their hormones, and cross referencing it with other factors like match congestion.

“It’s definitely a jigsaw,” she says. “And it’s about sort of putting all the pieces together.

“But once we have all the pieces, we don’t necessarily know which factor is going to play a bigger role on any given day. So it’s not like all of the pieces are the same size. Some days, a particular factor that might influence this type of injury might be amplified, whereas on another day, it might be turned down.”

Biology remains a large part of the answer

But even then the difference between female and male body types – which in the past led to some dismissing women as too “fragile” to play traditionally male sports – may not be as much of a factor as previously thought.

Because in some sports, the ACL injury discrepancy disappears.

“If you compare sports, where males and females start at the same age, have the same training intensity throughout their sporting life, and perform the same movements during that sport, then actually, the rupture rates equalise,” Mr Jones, the surgeon, says.

“And a very good example for that is elite dancers. So elite dance athletes, where the males and females start their training at the same age, they perform the same pivoting, jumping, twisting movements, and they have the same intensity of training and the same conditions. If you compare their rupture rates, they’re actually equalised.”

“And what that suggests is the impact of your training and your conditioning is really essential and avoiding this injury.”

Every expert I spoke to stressed the role of strength and conditioning in preventing injury. Here, nurture influences nature.

“We have that attitude of, you know, women do yoga, and pilates and men lift heavy things in the gym,” Ms Kryger says.

“But the reality is everyone needs to lift heavy things occasionally to prevent injuries and have a healthy body.”

England's Beth Mead has also been ruled out due to injuries. Pic: AP
Image:
England’s Beth Mead has also been ruled out due to injuries. Pic: AP

Read more:
Women’s World Cup warm-up match abandoned after 20 minutes
World Athletics criticised over decision to exclude trans women from female events

The good news is that quantifiable progress is being made here.

Matt Whalan is a sports scientist who works with the Australian men’s and women’s football teams – the Matildas who will be competing in the World Cup. He spoke to me from the men’s under 23s camp there.

Football Australia introduced a programme called ‘Perform+’, which can be worked into warm ups, that has reduced injuries, including ACLs, by 40%.

And crucially, it’s not just for elite players.

“This is designed so that mom and dad coaches can just go online, take down the programme, all the videos are there, there’s information about how you can deliver it with your athletes, and from under-sevens through to 55-year-olds, 95-year-olds, if you want to, you can do these exercises,” Mr Whalan says.

“The benefit of that for us at the higher end level, working with national teams, is if we have players that have been doing that, since they’re 12,13,14 years old, it makes our lives a lot easier.”

That remains in the future. When the World Cup starts next week, it will do so without a host of stars.

As England forward Chloe Kelly tells Sky News: “Having suffered the ACL injury myself, it’s so sad when you see so many players suffering that injury. Hopefully, we get the research that we need to stop these injuries happening so often.”

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As hate crimes against Muslims rise, govt urged to adopt new definition of Islamophobia in full

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As hate crimes against Muslims rise, govt urged to adopt new definition of Islamophobia in full

A long-awaited definition of Islamophobia is expected within weeks – and a former faith minister is urging the government to adopt it in full.

It is expected that the government will move away from the word “Islamophobia”, instead replacing it with “anti-Muslim hostility”.

But Lord Khan, who oversaw the start of the review into the definition, told Sky News the government must adopt the full new definition to tackle hate against Muslims.

Lord Khan. Pic: PA
Image:
Lord Khan. Pic: PA

The Labour peer, who was faith minister until the September reshuffle, told Sky News: “I hope it’s a clear definition which reflects the terms of reference which protects people, and it’s clear.

“There’s so many definitions out there, this is an opportunity to address the big problem in our communities.

“I would request and urge the government to adopt the definition which fits within the terms of reference on what we wanted to do when we embarked on the process.

“It’s a strong message to our communities that the work that should be done isn’t being done – these are lived experiences and I am one of those people who has suffered.”

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There was a suspected arson attack at a mosque in East Sussex earlier this month. Pic: Eddie Mitchell
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There was a suspected arson attack at a mosque in East Sussex earlier this month. Pic: Eddie Mitchell

Chaired by former Conservative minister Dominic Grieve, an independent working group has been looking at whether to produce a new definition of Islamophobia since February as part of a government bid to tackle the rise in hate crimes towards British Muslims.

Its aim was to “define unacceptable treatment, prejudice, discrimination and hate targeting Muslims or anyone who is perceived to be Muslim”.

From the beginning, ministers have insisted that any new definition would not infringe on freedom of speech, that it would protect the right to criticise, express dislike of, or insult religions and it would not pave the way for blasphemy laws to pass “through the back door”.

In 2021, Labour adopted a working definition of Islamophobia from a cross-party group supported by Wes Streeting, which said: “Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslimness or perceived Muslimness.”

This old definition has formed the basis of the Conservatives’ concern with the government’s policy on this new one.

Read more: ‘Most dangerous’ time to be Muslim in UK, monitor says

Tory shadow equalities minister Claire Coutinho told Sky News: “I think we all need to be equal in the law and there is already protection in the law – if you are a victim of violence or harassment based on your religion – those protections are already in place.

“What I deeply worry about is putting one group on a pedestal and giving them special protections because that will only breed resentment.”

When pressed on why other protected groups should have a definition, she said: “With the antisemitism definition, there was an international consensus and it was combating a specific thing, which was Holocaust denial.

“If you look at this definition, it’s based on an earlier version and one of the things it said in 2018 was that even talking about the grooming gangs was a form of anti-Muslim hatred.”

Claire Coutinho. Pic: PA
Image:
Claire Coutinho. Pic: PA

British Muslims say they still face discrimination – and without a specific definition of Islamophobia, crimes can often go underreported. According to multiple monitoring groups, hate crimes have gone up significantly, with Home Office data showing a surge of 20% last year, making Muslims the target in nearly half of religion-based offences.

However, policy groups say the result of adopting a definition could be a “fundamental social and structural change” by the back door, without democratic consent.

The Policy Exchange thinktank claimed that if the government adopts a fixed definition, activists will use it to challenge counter-terrorism laws and undermine the Prevent programme, which aims to steer people away from extremism.

Ministers are set to decide in the coming weeks on what they will adopt in the report and whether it will be published, with Communities Secretary Steve Reed formally making the announcement when that decision is made.

A Ministry of Housing, Communities and Local Government spokesperson said: “We do not comment on leaks. The department is carefully considering the independent Working Group’s advice on a definition of anti-Muslim hatred/Islamophobia, and no government decisions have been made.

“We will always defend freedom of speech, including fiercely protecting the right to criticise, express dislike of, or insult religions and the beliefs and practices of those who follow them. This will remain at the front of our minds as we review the definition.”

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The groundbreaking breeding programme that’s reducing methane in cow burps

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The groundbreaking breeding programme that's reducing methane in cow burps

Cows bred to produce less methane in their burps could prove to be an important ally in the fight against climate change, scientists have told Sky News.

A groundbreaking breeding programme in Scotland is proving so successful that the amount of the greenhouse gas produced by cattle when they belch or break wind could fall by 40% in just 20 years.

Cows and other farm animals produce at least 12% of global methane emissions, according to the Food and Agriculture Organisation of the United Nations.

But reducing levels could have a significant impact on global warming.

The gas traps 80 times more heat in the atmosphere than carbon dioxide in the first two decades after it’s released. But it breaks down after only 12 years – so reducing emissions would have rapid results.

Professor Mike Coffey, from Scotland’s Rural College, said calves born in the Cool Cows breeding programme produce 2% less methane than their parents.

“It’s permanent and cumulative. So once you’ve got an animal that produces less methane, she produces less for life,” he explained.

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“When you mate her to a lower methane-producing bull her offspring produce even less than she did.

“And you just keep going on and on. Over 20 years, you can reduce it by 40%.”

Methane is produced from cows, sheep and other ruminant animals when microbes in their guts digest grass and other feed.

The amount of the gas released by animals varies, partly because of the number and type of bugs in their stomach. And that’s influenced by inherited genetic factors in the cattle.

A new DNA test made by the company Semex can predict which animals will produce less methane, allowing scientists to match up bulls and cows for the breeding programme.

IVF techniques are then used to produce five or six calves in surrogate mothers each year, rather than the one that would normally be possible.

It means scientists can pick the best animal to breed from, leading to more rapid methane reductions without any genetic modification.

‘Entirely vegan world not feasible’

Agriculture currently accounts for 10% of the UK’s greenhouse gas emissions, with the country’s nine million cows and calves a significant contributor.

The National Farmers’ Union has set a target of reducing greenhouse gas emissions to net zero by 2040.

Food sustainability experts say breeding cattle that produce less methane is a significant advance, but not enough.

Emma Garnett, from the University of Oxford, said livestock still produce large amounts of manure that also releases greenhouse gases.

“Yes, let’s make things more efficient if we can, because I don’t think an entirely vegan world is a feasible,” she said.

“But it must not be used as a smoke screen for not shifting to more plant-based diets. The most effective way to reduce methane from cows is to farm fewer cows.”

Read more from Sky News:
The beef market is in turmoil – and inflation is spiralling

Parkinson’s patient plays clarinet during brain surgery

Beef consumption has already fallen by 62% since 1980, according to recent government figures.

Much of that has been because of concerns over health and animal welfare, but in recent years the climate impacts of cattle farming have become more widely known.

However, cheese consumption is increasing.

Professor Coffey said: “If you choose to eat meat or dairy, we are trying to produce it with lower impact.

“Just like if you chose to drive a car, you can choose to drive a car that has less emissions or you can choose to go on the bus.

“What we are doing here is providing consumers a choice and farmers the tools to enable that choice to be made.”

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UK weather: Four Met Office warnings in place as Storm Benjamin hits

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UK weather: Four Met Office warnings in place as Storm Benjamin hits

Yellow weather warnings for strong winds and heavy rain have been issued overnight – as Storm Benjamin sweeps through the UK.

The Met Office has issued four alerts – and has warned flooding, power cuts and travel disruption are possible.

Forecasters say damage to buildings is possible, with “a small chance of injuries and danger to life being caused by large waves” as the storm moves from the English Channel to the North Sea.

Britons who live in coastal areas are being urged to check their properties and “consider preparing a flood plan”.

Check the weather forecast where you are

The morning commute, for some, may be tricky. Filepic: PA
Image:
The morning commute, for some, may be tricky. Filepic: PA

A yellow warning for rain covering most of southern England, the East Midlands, parts of Wales and Yorkshire came into force at midnight and will expire at 6pm tonight.

Up to 30mm of rain is expected quite widely – rising to 50mm in some places, and even 90mm in isolated areas.

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An additional alert covering East Anglia and Lincolnshire expires at 9pm.

Large parts of southeast England are also under a yellow warning for wind from 3am until midnight – with gusts of 50mph to 60mph widely possible, potentially rising to 70mph near coasts.

A final warning for wind applies in Cornwall, Devon and the west coast of Wales from 6am until 3pm.

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Is UK ready for more extreme weather?

Chief meteorologist Rebekah Hicks said: “It is worth noting that there is a greater than usual uncertainty surrounding the track and intensity of this low pressure system.

“The public should stay up to date with the latest forecasts and warnings as the situation evolves, with adjustments to the forecasts likely at short notice.”

Storm Benjamin was named by Meteo France, the French national meteorological service.

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