Why are women footballers facing an ‘epidemic’ of ACL injuries?

Published

2 years ago

July 15, 2023

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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?”

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.”

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.”

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.”

UK

Who was at the Pope’s funeral – and who wasn’t

Published

7 hours ago

April 26, 2025

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Who was at the Pope's funeral - and who wasn't

The Pope’s funeral is taking place today at St Peter’s Basilica at the Vatican.

A pope’s funeral traditionally brings world leaders together, and several were in attendance.

Watch full coverage of the Pope’s funeral live on Sky News from 8am

Here’s a look at the list.

Prince William

The Prince of Wales attended the funeral of Pope Francis on behalf of the King.

The King was in Rome with Queen Camilla earlier this month, and met the pontiff at the Vatican.

The trip came just a week-and-a-half after Buckingham Palace confirmed the King had been taken to hospital following side effects related to his ongoing cancer treatment.

Sir Keir Starmer

Number 10 confirmed the prime minister received an invite and so he attended the ceremony.

Speaking on Tuesday, Sir Keir said there had been “an outpouring of grief and love” for the Pope.

He added: “I think it reflects the high esteem in which he was held, not just by millions and millions of Catholics, but by many others, across the world, myself included.”

Donald Trump

The US president was one of the first to confirm he would be flying to Rome, adding he would be joined by first lady Melania Trump.

Writing on his social media platform Truth Social on Monday, he said: “Melania and I will be going to the funeral of Pope Francis, in Rome. We look forward to being there!”

The Pope had been critical of Mr Trump at times during his tenure.

In January, he said it would be a “disgrace” if the president went ahead with his crackdown on immigration, telling an Italian television station: “It would make the migrants, who have nothing, pay the unpaid bill.

“It doesn’t work. You don’t resolve problems this way.”

Volodymyr Zelenskyy

The Ukrainian president, who met the Pope three times, was also in attendance – and there was an outbreak of applause for him when he arrived.

Mr Zelenskyy has said his country is grieving the Pope and recalled how he often prayed for peace in Ukraine.

Emmanuel Macron

The French President Emmanuel Macron also attended the funeral with his wife Brigitte.

In his tribute on Monday, Mr Macron said of the Pope: “In this time of war and brutality, he had a sense for the other, for the most fragile.”

Giorgia Meloni

The Italian premier, along Argentine leader Javier Milei (below) had place of pride in the seating order for the service.

The Vatican is, of course, surrounded by the Italian capital Rome, while the Pope was born and grew up in Argentina and was once Archbishop of Buenos Aires.

Javier Milei

The president of Pope Francis’s native Argentina was also at the ceremony, despite having launched insults at Francis in recent years.

Before taking office in December 2023, the far-right politician called him “an imbecile, the representative of evil on Earth”.

Mr Milei alluded to their “differences” in his tribute to the late Pope, writing: “It is with profound sorrow that I learned this sad morning that Pope Francis, Jorge Bergoglio, passed away today and is now resting in peace.

“Despite differences that seem minor today, having been able to know him in his goodness and wisdom was a true honour for me.”

Joe Biden

Former US president Joe Biden, 82, was at the funeral with his wife Jill. The couple were seen taking their places in the bright sunshine prior to the service.

Mr Biden appeared to be getting some help to his seat, taking the arm of a member of the church.

Lula da Silva

The Brazilian president and first lady Janja Lula da Silva were also at the funeral.

Brazil had also declared a seven-day mourning period for the Pope.

“Humanity is today losing a voice of respect and welcome for others,” the president said in his tribute.

“Pope Francis lived and propagated in his daily life the love, tolerance and solidarity that are the basis of Christian
teachings.”

Ursula von der Leyen

The EU Commission President confirmed she was attending after calling Francis a worldwide inspiration.

“He inspired millions, far beyond the Catholic Church, with his humility and love so pure for the less fortunate,” she said in her tribute.

Council President Antonio Costa, Parliament President Roberta Metsola was also expected to be in attendance.

Here are some of the other notable attendees:

• Ireland’s taoiseach Micheal Martin
• Spain’s King Felipe and Queen Letizia
• Albanian president Bajram Begaj
• Angola’s president Joao Lourenco
• Austrian president Alexander Van der Bellen
• Bangladesh’s chief adviser and interim leader Muhammad Yunus
• Belgium’s King Philippe and Queen Mathilde, along with prime minister Bart De Wever
• Canada’s governor general Mary Simon
• Cape Verde president Jose Maria Neves
• Croatia’s president Zoran Milanovic
• Cyprian president Nikos Christodoulides
• Czech Republic’s prime minister Petr Fiala
• Democratic Republic of Congo president Felix Tshisekedi
• Dominican Republic’s president Luis Abinader
• East Timor’s president Jose Ramos-Horta
• Ecuador’s president Daniel Noboa
• Estonia’s president Alar Karis
• Finland’s president Alexander Stubb
• Gabon’s president Brice Oligui Nguema
• German president Frank-Walter Steinmeier and outgoing chancellor Olaf Scholz
• Greece’s prime minister Kyriakos Mitsotakis
• Honduras president Xiomara Castro
• Hungary’s president Tamas Sulyok
• Italy’s president Sergio Mattarella and prime minister Giorgia Meloni
• Latvian president Edgars Rinkevics
• Lithuanian president Gitanas Nauseda
• Moldova’s president Maia Sandu
• Netherlands’ prime minister Dick Schoof
• New Zealand’s prime minister Christopher Luxon
• Norway’s Crown Prince Haakon and Crown Princess Mette-Marit
• The Philippines’ president Ferdinand Marcos Jr
• Poland’s president Andrzej Duda
• Portugal’s president Marcelo Rebelo de Sousa and prime minister Luis Montenegro
• Romania’s interim president Ilie Bolojan
• Sweden’s King Carl XVI Gustaf, Queen Silvia and prime minister Ulf Kristersson
• Switzerland’s president Karin Keller-Sutter

Who was not there?

Vladimir Putin

The Russian president did not attend the funeral.

But the controversial leader paid tribute to the Pope, writing a message to Cardinal Kevin Farrell, who is interim chief of the Catholic Church.

“Please accept my most sincere condolences on the passing of His Holiness Pope Francis,” Mr Putin said.

“Throughout the years of his pontificate, he actively promoted the development of dialogue between the Russian
Orthodox and Roman Catholic churches, as well as constructive cooperation between Russia and the Holy See.”

Benjamin Netanyahu

Israeli Prime Minister Benjamin Netanyahu also did not attend the ceremony, with the country’s ambassador Yaron Sideman going instead.

The Jewish state and the Vatican have had strong relations in the past, with Israel sending a presidential delegation to the funeral of Pope John Paul II in 2005, and Pope Francis visiting Israel in 2014.

But their relationship has deteriorated since the start of the war in Gaza.

A month after the conflict started in 2023, a dispute broke out over whether Pope Francis had used the word “genocide” to describe events in Gaza. Palestinians who met with him said he did, but the Vatican said he did not.

The Pope met relatives of Israeli hostages on the same day.

Israeli officials have since lobbied the Vatican to be more forceful in its condemnation of Hamas.

In January, the Pope called the humanitarian situation in Gaza “shameful”, prompting criticism from Rome’s chief rabbi, Riccardo Di Segni, who accused Francis of “selective indignation”.

Rabbi Di Segni said he would be attending the funeral, despite it taking place on the Jewish sabbath.

Was there a seating plan?

The seats were assigned in advance, with the heads of state sitting in French alphabetical order based on their country’s name, rather than on the individual’s.

This applied to everyone apart from the presidents of Italy and Argentina, who got the best seats because the Pope lived in Italy and was an Argentinian native.

UK

Virginia Giuffre, who accused Prince Andrew of sexual assault, has died, her family says

Published

13 hours ago

April 26, 2025

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Virginia Giuffre, who accused Prince Andrew of sexual assault, has died, her family says

Virginia Giuffre, who accused Prince Andrew of sexual assault, has died aged 41.

In a statement to Sky’s US partner network NBC News on Friday, her family said she took her own life in the Perth suburb of Neergabby, Australia, where she had been living for several years.

“It is with utterly broken hearts that we announce that Virginia passed away last night at her farm in Western Australia,” her family said.

“She lost her life to suicide, after being a lifelong victim of sexual abuse and sex trafficking.

“Virginia was a fierce warrior in the fight against sexual abuse and sex trafficking. She was the light that lifted so many survivors.

“In the end, the toll of abuse is so heavy that it became unbearable for Virginia to handle its weight.”

Police said emergency services received reports of an unresponsive woman at a property in Neergabby on Friday night.

“Police and St John Western Australia attended and provided emergency first aid. Sadly, the 41-year-old woman was declared deceased at the scene,” a police spokeswoman said.

“The death is being investigated by Major Crime detectives; early indication is the death is not suspicious.”

Sexual assault claims

Ms Giuffre sued the Duke of York for sexual abuse in August 2021, saying Andrew had sex with her when she was 17 and had been trafficked by his friend, the billionaire paedophile Jeffrey Epstein.

The duke has repeatedly denied the claims, and he has not been charged with any criminal offences.

In March 2022, it was announced Ms Giuffre and Andrew had reached an out-of-court settlement – believed to include a “substantial donation to Ms Giuffre’s charity in support of victims’ rights”.

She stuck by her version of events until the end

Of the many dozens of victims of Jeffrey Epstein, it was Virginia Giuffre who became the most high-profile.

She was among the loudest and most compelling voices, urging criminal charges to be brought against Epstein, waving her right to anonymity in 2015.

She told how he and Ghislaine Maxwell groomed her and “passed around like a platter of fruit” to be used by rich and powerful men.

But her name and face became known around the world after she accused Prince Andrew of sexually abusing her when she was 17 years old.

The picture of her together with the prince and Maxwell at the top of a staircase, his hand around her waist, is the defining image of the whole scandal.

Prince Andrew said he had no memory of the occasion. But Giuffre stuck by her version of events until the end.

‘An incredible champion’

Sigrid McCawley, Ms Giuffre’s attorney, said in a statement that she “was much more than a client to me; she was a dear friend and an incredible champion for other victims”.

“Her courage pushed me to fight harder, and her strength was awe-inspiring,” she said. “The world has lost an amazing human being today.”

“Rest in peace, my sweet angel,” she added.

Dini von Mueffling, Ms Giuffre’s representative, also said that “Virginia was one of the most extraordinary human beings I have ever had the honour to know”.

“Deeply loving, wise, and funny, she was a beacon to other survivors and victims,” she added. “She adored her children and many animals.

“She was always more concerned with me than with herself. I will miss her beyond words.

“It was the privilege of a lifetime to represent her.”

Ms Giuffre said at the end of March she had four days to live after a car accident, posting on social media that “I’ve gone into kidney renal failure”. She was discharged from hospital eight days later.

Raised mainly in Florida, she said she was abused by a family friend early in life, which led to her living on the streets at times as a teenager.

She said that in 2000, she met Ghislaine Maxwell, a British socialite who was convicted in 2021 on federal sex trafficking and conspiracy charges and was sentenced to 20 years in prison.

Ms Giuffre said Maxwell then introduced her to Epstein and hired her as his masseuse, and said she was sex trafficked and sexually abused by him and associates around the world.

‘A survivor’

After meeting her husband in 2002, while taking massage training in Thailand at what she said was Epstein’s behest, she moved to Australia and had a family.

She founded the sex trafficking victims’ advocacy charity SOAR in 2015, and is quoted on its website as saying: “I do this for victims everywhere.

“I am no longer the young and vulnerable girl who could be bullied. I am now a survivor, and nobody can ever take that away from me.”

:: Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.

UK

Who will be at the Pope’s funeral – and who won’t be

Published

13 hours ago

April 26, 2025

admin

Who will be at the Pope's funeral - and who won't be

The Pope’s funeral will take place today at St Peter’s Basilica at the Vatican.

A pope’s funeral traditionally brings world leaders together, and some have already revealed they are attending.

Watch full coverage of the Pope’s funeral live on Sky News from 8am

Here’s a look at the list.

Prince William

The Prince of Wales will attend the funeral of Pope Francis on behalf of the King, Kensington Palace has said.

The King was in Rome with Queen Camilla earlier this month, and met the pontiff at the Vatican.

The trip came just a week-and-a-half after Buckingham Palace confirmed the King had been taken to hospital following side effects related to his ongoing cancer treatment.

Sir Keir Starmer

Number 10 has confirmed the prime minister received an invite and will attend the ceremony.

Speaking on Tuesday, Sir Keir said there had been “an outpouring of grief and love” for the Pope.

He added: “I think it reflects the high esteem in which he was held, not just by millions and millions of Catholics, but by many others, across the world, myself included.”

Donald Trump

The US president was one of the first to confirm he would be flying to Rome, adding he would be joined by first lady Melania Trump.

Writing on his social media platform Truth Social on Monday, he said: “Melania and I will be going to the funeral of Pope Francis, in Rome. We look forward to being there!”

The Pope had been critical of Mr Trump at times during his tenure.

“It doesn’t work. You don’t resolve problems this way.”

Volodymyr Zelenskyy

The Ukrainian president, who met the Pope three times, is expected to attend, according to officials in Ukraine.

In his tribute, Mr Zelenskyy said his country was grieving the Pope and recalled how he often prayed for peace in Ukraine.

Emmanuel Macron

The French president told local reporters he would be going to the funeral.

In his tribute on Monday, Mr Macron said of the Pope: “In this time of war and brutality, he had a sense for the other, for the most fragile.”

Javier Milei

The president of Pope Francis’s native Argentina will attend, despite having launched insults at Francis in recent years.

Before taking office in December 2023, the far-right politician called him “an imbecile, the representative of evil on Earth”.

“Despite differences that seem minor today, having been able to know him in his goodness and wisdom was a true honour for me.”

Lula da Silva

The Brazilian president and first lady Janja Lula da Silva will be at the funeral, the country’s government announced.

Brazil has also declared a seven-day mourning period for the Pope.

“Humanity is today losing a voice of respect and welcome for others,” the president said in his tribute.

“Pope Francis lived and propagated in his daily life the love, tolerance and solidarity that are the basis of Christian
teachings.”

Ursula von der Leyen

The EU Commission President confirmed she would be attending after calling Francis a worldwide inspiration.

“He inspired millions, far beyond the Catholic Church, with his humility and love so pure for the less fortunate,” she said in her tribute.

Council President Antonio Costa, Parliament President Roberta Metsola are also expected to attend.

Here are some of the other notable attendees:

Who won’t be there?

Vladimir Putin

The Russian president will not be attending the funeral, the Kremlin has confirmed.

But the controversial leader paid tribute to the Pope, writing a message to Cardinal Kevin Farrell, who is interim chief of the Catholic Church.

“Please accept my most sincere condolences on the passing of His Holiness Pope Francis,” Mr Putin said.

Benjamin Netanyahu

The Israeli prime minister is not expected to attend, with the country’s ambassador Yaron Sideman going instead.

But their relationship has deteriorated since the start of the war in Gaza.

The Pope met relatives of Israeli hostages on the same day.

Israeli officials have since lobbied the Vatican to be more forceful in its condemnation of Hamas.

In January, the Pope called the humanitarian situation in Gaza “shameful”, prompting criticism from Rome’s chief rabbi, Riccardo Di Segni, who accused Francis of “selective indignation”.

Rabbi Di Segni says he will be attending the funeral, despite it taking place on the Jewish sabbath.

Is there a seating plan?

The seats are assigned in advance, with the heads of state sitting in French alphabetical order based on their country’s name, rather than on the individual’s.

This applies to everyone apart from the presidents of Italy and Argentina, who get the best seats because the Pope lived in Italy and was an Argentinian native.