Tottenham launch internal review into ACL injury crisis after season of setbacks

Tottenham initiate formal review after spate of ACL injuries

Tottenham Hotspur have launched an internal review into the high number of anterior cruciate ligament injuries suffered by first-team players this season. The club's medical and performance staff will examine whether training load, pitch surface, or recovery protocols contributed to the unusual cluster of serious knee injuries that has derailed their campaign.

Context and background: an unusual injury cluster

Spurs have seen several first-team players, including Cristian Romero, James Maddison, and Micky van de Ven, sidelined with ACL tears at different points this term. Such a concentration of long-term knee injuries at one club is rare and has prompted the board to order a comprehensive audit of the club's sports science and medical practices.

Romero, a cornerstone of Ange Postecoglou's defence, suffered his ACL injury in November 2024 and is not expected back until late 2025. Van de Ven's ACL issue in February 2025 came just as he was regaining form. The cumulative absences have forced Postecoglou into 12 different centre-back pairings this season and have severely limited his ability to implement his high-pressing, attacking system.

According to Premier League injury data, Tottenham have recorded 9.3 days lost per player to injury this season, the second-worst in the division. Their ACL count of three is double the league average. The review will also assess the potential impact of the club's move to a hybrid grass pitch at Tottenham Hotspur Stadium last summer, a change that some players have criticised for being harder on joints.

Impact on the squad and Postecoglou's system

The injury crisis has directly undermined Postecoglou's favoured 4-3-3 formation, which relies on aggressive full-backs and centre-backs stepping into midfield. With key defenders missing, Spurs have conceded 1.63 goals per game in matches without at least one of Romero or Van de Ven, compared to 0.94 when both are fit. The manager has been forced to field makeshift defensive units, reducing their ability to compress the pitch and press high.

The review's findings could lead to significant changes in training load management. Tottenham currently rank fifth in the league for high-intensity running distance per 90 minutes, a metric Postecoglou encourages. But the injury rate suggests a mismatch between physical demands and recovery periods. The club may adopt a more individualised approach, similar to Arsenal's rotation strategy this season, which has helped them avoid major muscular injuries despite a packed schedule.

For Fantasy Premier League managers, the situation is critical. Romero (£5.1m) and Van de Ven (£4.8m) were popular budget defensive picks earlier in the season, but their long-term absences have slashed ownership. Destiny Udogie (£5.5m) also missed six weeks with a hamstring issue, and Pedro Porro (£5.9m) has struggled with minor knocks. Tottenham's remaining fixtures include matches against top-six sides, limiting their clean sheet potential. FPL managers should avoid Spurs defenders until the review's recommendations are implemented and the injury situation stabilises.

Three ACL injuries in one season is abnormal; Tottenham's last ACL case was in 2022 (Ben Davies).
Postecoglou's high-intensity style may be a contributing factor; Spurs' distance covered per game ranks in the top four.
The club's move to hybrid grass in 2023 has been linked to increased injury risk, though no conclusive link has been proven.

What comes next after the review

The club expects to publish a summary of the review's findings before pre-season in July 2025. Depending on outcomes, Tottenham may overhaul their medical team, introduce mandatory GPS monitoring for all training sessions, and invest in new cryotherapy and recovery equipment. Immediate changes could include reduced training volume during match weeks. The stakes are high: without a fit squad, securing a European place for 2025-26 will be difficult, and Postecoglou's long-term project could be undermined by recurring injuries.