Sam Kerr ‘strongly advised’ against playing at 2024 Paris Olympics following second ACL injury

Matildas captain Sam Kerr ruptured the Anterior Cruciate Ligament (ACL) in her right knee just months out from the 2024 Summer Olympics.

And when the shattering news was announced on January 8, football fans around Australia, and the world, held their collective breaths.

The 30-year-old suffered the injury during her club Chelsea’s warm weather training camp in Morocco.

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ACL injuries require reconstruction surgery and can take nine to 12 months to recover from, though some can take longer.

Thoughts first turned to Kerr missing the Paris Olympics in June, but many fans may have overlooked the long-term and often career-ending complications of the injury.

Female athletes are about eight times more likely than men to suffer an ACL tear, according to the US National Institute of Health.

Academic director at Sydney Biomechanics Laboratory Suzi Edwards said ACL injuries are a billion dollar problem in Australia.

Over the past 20 years in Australia, records of the injury have increased by 43 per cent for men and women, with about 77 ACL ruptures occurring in every 100,000 Aussies, according to research from Edwards.

Cases are also becoming more common in young children aged five to 15, with an increase of 24 per cent over that same period.

Edwards, who has herself suffered ACL injuries, said it was previously thought safe to return to sport just six months after reconstruction, but the thinking around post-surgery has since changed.

“I actually had five ACL reconstructions by the time I was 20 years old,” she said.

“And that completely ended my career in basketball.”

Edwards explained after one injury, she returned to basketball six months post-surgery, only to rupture her ACL again during a jump shot at her second training session back.

Sam Kerr’s Olympics prospects

“Technically, there are cases of accelerating the return to sport and potentially getting Sam back to the Olympics, which is in that 5-6 month time frame,” she said.

“But there’s also that high risk that she’ll re-rupture that ACL.

“Therefore, you need to balance and weigh up the benefits of the short-term goal of making the Olympics versus her long-term career.”

Given all this, Edwards “strongly advises” against Kerr competing in the upcoming Olympics.

She added Kerr’s return will come down to a “team approach” based on what the superstar wants, and what her sports medicine team recommends.

It’s not the first time Kerr has injured her ACL. In 2011, she suffered a similar injury that ruled her out of the 2012 Olympics in London. More recently, she missed a number of games in the 2023 FIFA World Cup hosted on home soil after a calf injury.

“As we saw with her calf, with her sitting out of some World Cup games, you really (need to think about) the long-term approach of health management for the player, particularly a professional player like Sam,” Edwards said.

“So it really depends if she’s passionate, she could return. But it does increase her risk, and it would probably be strongly advised to Kerr not to return for the Olympics.”

Long-term implications

Typically, after an injury such as Kerr’s, the athlete will require reconstruction, Edwards said.

She warned anyone who has sustained an ACL injury, whether they take a surgical or non-surgical approach, may suffer from long-term osteoarthritis (a degenerative joint disease).

“So, we have to not just think about the short-term implications of these injuries … but we need to think about the long-term consequences because most athletes we’ve seen after this injury will have the signs of developing osteoarthritis,” Edwards said.

An athlete’s performance will likely be tested, she said.

“One of the things we see a lot is athletes coming back too soon and losing their confidence and not being able to return to the sport and play at the same level.

“We need to manage all the different factors that impact the athlete as well as look at the injury mechanism, so how the athlete did the injury, and then looking at what rehabilitation they may need.”

What is being done to help female athletes?

ACL injuries are “multifactorial”, Edwards explained, meaning an evidence-based approach is needed to prevent, and treat the injury.

“They occur typically during a changing of direction. A lot of females play sports like netball … we see high incidence rates, but we have to look at other factors,” she said.

“Part of that might be looking at ACL injury prevention programs such as the neuromuscular training programs, that’s typically a 20-minute warm-up training program, preparing the athlete before they start training.”

Some factors, including gender and genetics, putting athletes more at risk of an ACL injury cannot be prevented. It is not yet clear why women are more likely to suffer the injury than men.

“Another factor is hormones, and we are looking at female athletes and the menstrual cycle,” Edwards said.

“And there has been some evidence of that risk, but the problem is that some athletes may be on a contraceptive pill with differing hormones, and we just don’t have enough evidence yet to find a clear link between the hormones, the menstrual cycle and injuries.”

Edwards said more funding was needed to better research how ACL injuries impact female athletes.

“This is where we are looking at applying for more research funding … but it’s really hard to get funding on sports injuries alone,” she said.