There have been a number of Ballon d’Or winners, and nominees, who have succumbed to ACL injuries in the modern era. Sadly, players enduring a tear or rupture of the anterior cruciate ligament has become an all-too-frequent occurrence – especially when compared to times past - with a greater volume of games and increased intensity contributing factors.

In the 2024/25 Premier League season alone, eleven players were downed long-term with this particular injury. Across this present campaign Tottenham have seen three first-team regulars forced onto the sidelines for months at a time with ACLs.

This, obviously, is an extremely worrying development, but if there is a consolation to be found it lies in the advancements of medical science and physiotherapy.

Time was when an ACL often spelled the end of a player’s career, while others returned a year later, a shadow of their former selves. Now, typically, an operation commences, that reconstructs the damaged knee joint by grafting onto it the middle third of the injured player’s patellar tendon. Screws are put in place and in due course the ‘new’ bone plugs at each end, with the femur and tibia.

Then comes the rehab. The long months and hard miles. The little but significant victories that require both dedication and patience.

Mercifully, in most instances, the player is back on the grass completing agility drills six months later, with a meticulously planned schedule in place to have him back in action soon after.

Scaling Two Mountains  

In late October 2024, at the beautiful Théâtre du Châtelet, Paris, the current recipient of the Ballon d’Or, Rodri, was assisted onto the stage to receive his trophy.

Bandaged and on crutches, the Manchester City midfielder was aided to the podium by that evening’s event host Didier Drogba, the Spanish international subsequently giving an inspirational speech comparing his securement of a Ballon d’Or to a mountain being climbed, one step at a time.

Just five weeks earlier, the 29-year-old went down under an innocuous challenge at Arsenal and stayed down, his worst fears confirmed on being taken to hospital. A ruptured anterior cruciate ligament in his right knee.

Now he had an altogether more challenging mountain to scale.

It began with days of waiting, under sedation, as doctors assessed the extent of the damage, furthermore, allowing the worst of the inflammation to cede. After all, his knee had experienced a serious trauma.

Then came surgery – in Rodri’s case, in Madrid - followed by 72 hours of the RICE procedure. This stands for rest, ice, compression and elevation of the leg.

A period convalescing at home usually follows this early stage, as the player mentally prepares for months of structured rehabilitation. That starts with assessments and lots of them. Monitoring the swelling. Trying to settle the joint down. Gradually – and painfully – restoring a range of basic motions until the first meaningful landmark is reached, that of achieving full knee extension.

Structured progress: Restoring function and strength

And so to the gym, a place of business for the injured player for months to come.

An electro stimulation machine is used to maintain muscle bulk around the knee while blood flow restriction training gets underway, a process designed to force the knee muscles to work harder independently.

Once this has been achieved to a satisfactory standard the functional strength work can begin, a notable staging post because it is here when the strength and conditioning coaches and the physios merge and more strenuous demands are made of the player.

Crucially too, it is at this juncture when the crutches are discarded and a limp slowly becomes a normal walking gait.

Khuram Amin from Full Motion Physio has worked extensively with sports professionals, rehabilitating them after injury. He details the procedures that are put in place across this crucial juncture.   

“The functional training stage of ACL rehabilitation typically begins around four to six months post-surgery, once strength, range of motion, and neuromuscular control have been adequately restored.”

“This phase shifts the focus from isolated strengthening to sport-specific movement patterns, including cutting, pivoting, deceleration, and reactive agility drills designed to mimic the demands of competition.

Plyometric progressions and single-leg landing mechanics are emphasized to rebuild dynamic knee stability and reduce the risk of re-injury, which research shows remains elevated for up to two years post-reconstruction.

Successful completion of this stage hinges on objective return-to-sport testing, limb symmetry indices above 90%, hop test benchmarks, and psychological readiness, rather than time alone.”

By month four, Rodri was jogging: tentatively, but jogging all the same.

By month five he was breaking into his first run and we can easily imagine how joyous a moment that would have been. This is initially achieved via an Alter G, a special treadmill that allows players to run on a certain percentage of their body weight.

Protocols of Patience: Low-Intensity Drills and Back on the Grass

When Rodri’s injured leg had 90% of the capacity of his other leg, talk turned to training. He was back with the lads, revelling in that special feeling – previously perhaps taken for granted - of the grass growing underfoot.

Phase two of the final stages of the rehabilitation process included running protocols, starting with attainable goals such as completing 1km in four minutes.

This ran alongside technical conditioning, passing and dribbling that understandably remained strictly non-contact.

In due course, acceleration and deceleration drills were added to the load until finally the player was able to take part in team sessions, if partially at first.

The end was in sight. The nightmare almost over.

A Blueprint for Recovery: Those who came before

What must have helped Rodri in darker moments was the knowledge that so many players before him had endured the same ordeal, yet returned as impactful and brilliant as before.

Moreover, the long list includes many prestigious talents who have won a Ballon d’Or, or been nominated.   

In 2005, Rodri’s fellow countryman Xavi tore ligaments in his left knee when training but astonished Barcelona’s medical staff when he returned to action within six months.

The midfield genius attributed his quick recovery to ‘walking and jogging on flat terrain at 1,050 metres in the mountains’.

Five years later he was a World Cup winner.

Earlier still, Alan Shearer snapped his ACL when playing for Blackburn Rovers in 1992. Four years later the England legend finished third in the Ballon d’Or voting.

In more recent times, Virgil van Dijk required surgery after tearing an ACL in a Merseyside derby in 2020. This occurred less than a year after the giant centre-back finished behind only Lionel Messi in the Ballon d’Or awards, following a period of supreme dominance in the English top-flight.

After nine months’ absence the Dutchman was subsequently included in three PFA Team of the Years.

In the women’s game meanwhile, two-time Ballon d’Or Feminin winner Alexis Putellas suffered an ACL in the summer of 2022, as the Spanish national team prepared for the forthcoming Euros.

Like her compatriot Rodri, she collected one of her Ballon d’Or awards injured. Like him too, she was out of regular first-team action for nine months.

In April this year, Putellas made her 500th appearance for Barcelona.