Leah Williamson comforts Vivianne Miedema after she suffers ACL injury against Lyon
Arsenal striker Vivianne Miedema has been ruled out for "an extended period of time" after rupturing her ACL

Not anyone else.

When Miedema left the field on a stretcher with her hands covering her face, onlookers were already worried.

One of the worst injuries to have as a footballer was suffered by another of the world's best female players, who will be out for at least six months.

The all-time top scorer in the Women's Super League has joined an ever-expanding list which includes her partner and the winner of the Ballon d'Or.

There are renewed calls from players, fans and managers for more research into why this type of injury is more common in females than males.

The "fear" and "negativity" around the injury need to be changed, according to the England player. What is being done to decrease the risk?

'No proven cause'

Estimates range from two to eight times more likely for female football players to suffer a serious knee injury than for males.

A senior lecturer in sports medicine at St Mary's University in London said that recent discussions have focused on whether the injury risk is sex related or gender related.

She thinks there's some truth in all of them.

"We have to be careful when we talk about this in women's football because there is a tendency within research and within the media of being like 'oh, women are so unstable, fragile, because of their anatomy, their hormonal fluctuations' but we haven't proven that'"

Maybe it's the way we treat them. I want to see a change in people's perception of female athletes and women's football.

What are the main areas of concern?

This is the first thing. Body mechanics/anaysis.

The physical differences between men and women, such as women having wider hips, which increase the leg's angle into the knee, and under-developed muscles which prevent the knee from turning in upon landing, have been the subject of research.

There is no evidence to support the idea that this is the main risk factor.

There are two There are hormones.

It has been suggested that the menstrual cycle could make females more prone to injury. When oestrogen is elevated during the menstrual cycle, it can affect the stability of joints and cause them to loosen.

There is no evidence to support the idea that this increases the risk of injury. There has been some research done on the relationship between the menstrual cycle and the risk ofACL. You need saliva or blood samples to do it.

Predicting where in the phase women are based on when their period starts is the majority of the work. Predicting is all it is. It doesn't show much difference when you combine all the data.

When a player is on their period, they are more likely to get injured than when they are not, but the risk should be higher if they are expecting a baby.

There are three. There are gender differences.

A 2021 study published in the British Journal of Sports Medicine suggested looking at the influence of gender - pointing at external factors such as access to training, sport science, facilities and rehabilitation.

The amount of time and exposure an athlete has had to structured, coached and progressive training is likely to be lower for female football players.

The design of football kit and the pitches used in the WSL are among the gender differences highlighted. She pointed out that the risk of women getting their boot stuck in the surface was increased because of the length of the stud on the boots.

There are four. There is work load.

Increasing concern among managers and players in the game is a result of the rapid growth of the game.

With the amount of games and the limited recovery time, it's difficult to do anything about it.

Why are ACL injuries so serious?

Simone Magill had waited her entire career for Northern Ireland to make their debut at the Euros.

The dream was cut short when her side played Norway.

When I stuck my leg out to balance, I felt a pull from my leg, so I knew it wasn't good.

It was really bad. I wasn't a good person.

Eight of Magill's international team-mates went through it before her.

I was reassured by them in terms of reassurance. They were all examples that they went through it and came back.

I didn't know what to do. I heard about a lot of people doing theACL, but I didn't know what it meant.

She said that the injury is difficult because of the longevity and the need to relearn walking again.

I didn't remember the way you'd walk. In the house, standing in front of a mirror and just focusing on doing knee to toe, I had no idea that would happen.

I assumed I would have surgery, be sore for a while, and then it would all come back to me.

It was the mental part of it all. It doesn't feel like my knee, so I thought. Is it possible that it will never feel like my knee again?

It wasn't the first of the European Championship, with Spain star Putellas having been ruled out on the eve of the tournament, as well as France's Marie-Antoinette Katoto.

Magill thinks that there are underlying reasons why it happened. It's not just "oh it's part and parcel of the game and we have to accept it"

It's frightening at the moment.

A graphic showing a picture of Alexia Putellas

What is being done to try and reduce risk?

The biggest problem in women's football at the moment is the recovery time and the potential long-term impact on a player's career, which is why Dr Kryger works closely with a number of WSL teams.

Knowing how to tackle it is more difficult than they would like.

As the game is still growing and adapting to increased professionalism, one WSL club has recently recruited professionals to further research onACLs.

An advocate of injury prevention programmes at women's football clubs is Dr Andrew Greene.

Prior to becoming head of performance at Crystal Palace, he contacted every Championship club and some WSL sides about implementing a programme to target weaknesses in athletes.

The underlying mechanical issues that we know contribute to the injury are addressed by them.

He said that female athletes tend to have under-activated muscle groups.

Two of Palace's players had injured their knees in the previous year.

"If we can make sure the athletes are more prepared for the intensity of a game and they are used to stopping and changing direction in a controlled environment, those underlying capabilities are there and will assist in stabilising the joints and reduce the risk."

The facility of gym and conditioning programmes is getting better in the female game, but the access to the gym is limited in the Championship. Reliance on a once a week gym program isn't enough.

Over the past four seasons, the FA conducted a study into the prevalence of anterior cruciate injuries in women's football.

The results are due to be released in the new year and show that there were 0.1 injuries per 1,000 hours and 0.04 injuries per 1,000 training hours. The most common injury was the hamstring.

The FA said in a statement that the injury rates in the men's game have decreased in the past four seasons, however they will continue with their injury and illness monitoring work.

What more needs to be done?

Research is the study of things.

According to players, managers and academics, there hasn't been enough research into the causes of knee injuries.

The demands of the game are changing and we need to understand what that involves.

I don't think there's enough research available to come up with a plan for the women's game.

More large-scale research is what the doctor wants. A lot of the data comes from a single club. It's good that you don't have a lot of them in a season. It's only a small amount of data that you're going to get if you only have data for one team.

She is in the process of setting up more research and hopes to get funding for it.

One doctor who used to work at a WSL club and didn't want to be named said he wanted to see the whole football community push for equity of access to resources for female players.

He said that the challenge for the women's game was to get that kind of support. In the women's game, support staff aren't paid particularly well, so that means you're not getting the best.

It wouldn't have a lot of staff that an average men's team would have.