Physical preparation and return to performance of an elite female football player following ACL reconstruction: a journey to the FIFA Women’s World Cup

ACL injuries are among the most severe knee injuries in elite sport, with a high injury burden and re-injury risk. Despite extensive literature on the injury and the higher incidence of injury and re-injury in female athletes, there is limited evidence on the return to sport (RTS) of elite female football players following ACL reconstruction (ACLR). RTS is best viewed on a continuum aligning the recovery and rehabilitation process with the ultimate aim — a return to performance (RTP(erf)). We outline the RTS and RTP(erf) of an elite female football player following ACLR and her journey to the FIFA Women’s World Cup, including the gym-based physical preparation and the on-pitch/sports-specific reconditioning. We used the ‘control–chaos continuum’ as a framework for RTS, guiding a return above pre-injury training load demands while considering the qualitative nature of movement in competition. We then implemented the ‘RTP(erf) pathway’ to facilitate a return to team training, competitive match play and a RTP(erf). Objective information, clinical reasoning and shared decision-making contributed to this process and helped the player to reach her goal of representing her country at the FIFA Women’s World Cup.