Vivianne Miedema is missing the 2023 World Cup with an ACL tear. And as an observer, she is concerned about the growing number of injuries at the tournament and in women’s soccer overall.

The Netherlands star laid out the feelings she is going through as she watches this year’s World Cup, which have ranged from sadness to frustration to fear, she wrote Monday in an op-ed for The Athletic. Miedema tore her ACL in December in a match for Women’s Super League club Arsenal, but she had been advocating for a better solution to the injury problem in the women’s game even before her own ACL tear.

Already, the World Cup has seen one ACL tear – Haiti’s Jennyfer Limage went down against England in a match had to stop watching. To see other players tear their ACLs is “the hardest part of being injured,” Miedema wrote.

Many analysts and fans feared the worst when England’s Keira Walsh went down with an injury in the Lionesses’ next game. While Walsh avoided a tear, her knee injury still underscored the recent rash of injuries in the women’s game.

“It’s worrying that we live in a world where there’s a need to announce it’s not an ACL injury,” Miedema wrote in The Athletic. “Because so many players are out with ACL injuries, we think every player who goes down with a knee injury has one, too. That isn’t always the case. Not knowing the outcome keeps us all scared.”

Miedema pointed to the number of players already out with injuries, including the astounding number of players from the U.S. who are missing the tournament, from Becky Sauerbrunn to Mallory Swanson, Catarina Macario to Christen Press.

“Every time I watch women’s football at the moment, I’m waiting for the next big injury to happen,” Miedema wrote.

While she has been proud for her Arsenal teammates, including Australia’s Steph Catley, it is hard to realize that she and several of injured teammates “not there. You feel so proud – but so sad.”

FIFA and UEFA need to change the packed playing calendar – and take responsibility for the number of injuries, Miedema says. The workload is too heavy for players in a game that is becoming quicker, more intense and more physical. She also would like to see squad numbers grow internationally and domestically, and she would like to see more support from managers and clubs through increased player rotation and more medical staff.

Devastating to see the amount of injuries being picked up in this tournament so far…💔

This World Cup should have been played with a 26-player squad to reduce stress on players and to let coaches deal with injuries correctly. #FIFAWomensWorldCup2023

— Vivianne Miedema (@VivianneMiedema) July 28, 2023

“Before I got injured, I’d been playing every single game for my club or the national team for eight or nine years. It’s just too much,” she wrote. “One positive to being injured is that this is the first time in my adult life that I haven’t had the pressure of having to perform or be a leader.”

With the World Cup shining a spotlight, Miedema hopes the World Cup will make “stakeholders realize something needs to change.”

“To watch a World Cup with 10 of the best players out injured — either at the tournament or recuperating at home — is not a good advertisement for women’s football,” she continued. “From bitter experience, I know it’s even worse for the players themselves.”

Tobin Heath and Christen Press gave voice to what plenty of U.S. women’s national teams fans are thinking following the 1-1 draw with the Netherlands in the World Cup group stage.

The two-time World Cup champions are watching this year’s tournament from home and are breaking down each USWNT match as the hosts of “The RE-CAP Show.” On the latest episode, Heath and Press criticized the team’s decision-making, especially in what Heath called a “disastrous” first half.

“If I was to close my eyes right now, and if you were to tell me that we tied the Netherlands 1-1, I think I would have said, ‘OK, not terrible,’” she said. “But I didn’t close my eyes and watch that game. They were wide open. And what I will say is there’s a result and then there’s performance.”

Looking at the result, a 1-1 draw still gives the USWNT a solid chance to win Group E with a win against Portugal at 3 a.m. ET Tuesday.

“But performance — I mean, that first half was disastrous. And I don’t think there’s any one individual that you point to and say that individual didn’t play well,” Heath said. “I think I looked out on the field and I saw a lot of people that didn’t know what they were doing.”

After the USWNT entered the half trailing 1-0, a much-improved second half saw the team tie the score on a Lindsey Horan header. The energy and belief in the final 45 minutes reminded everyone “what we love cheering for about the U.S.,” Heath said. She also described how Horan had manifested her game-tying goal in conversation with Heath before the match.

“I’m so proud of her,” Heath said. “She told me that she was gonna do that, and she did it. Like, that to me is a U.S. women’s team captain. When the team needed something, she brought it.”

While the USWNT scored on a corner kick and finished with 11 in the match, Heath keeps “coming back” to the ways in which the team could be more effective on corner kicks and other set pieces. A lack of consistency has made it hard for the team to get the timing right, she said.

Later in the show, injured Netherlands striker Vivianne Miedema came on to discuss the match with Heath. Miedema echoed Heath’s tactical analysis, noting that the USWNT would have done well to create more width in their attack.

“If they would have made it a bit wider, you could have run at them. As you know yourself as a winger, you would have loved to get the ball and then go into one-on-one,” Miedema said. “I think you guys then create those opportunities.”

Miedema also questioned whether the USWNT’s tactics played to the strengths of its roster, specifically referring to Alex Morgan, who head coach Vlatko Andonovski has said is playing in a “bit of a different role” at this World Cup.

“I think it’s hard to see some of your players not being able to actually get into their strengths,” she said. “I think if you look at Alex Morgan, she’s probably one of the best strikers in the world for more than a decade now. But she obviously doesn’t get the balls into the box that she probably needs. So you probably need to adjust a bit to the players that you have, and I felt like in our game that didn’t happen.”

To Miedema, Rose Lavelle made a “big difference” in the second half, which helped the USWNT play better from that point.

Still, despite some stronger and weaker individual performances, the team’s play as a whole is the root of the problem. Press described an “intangible feeling” that is lacking so far from the 2023 squad.

“The reason that the U.S. women’s national has won consistently is because of the intangible, and the intangible feeling was there,” she said. “I was even just reading what people were saying in the second half and it was the feeling that every single person in this country believed that we were going to come back and score, and they played like that.

“And I’ve been on the pitch with this team and I haven’t felt that. And that’s what scares me the most.”

That does not mean the team will not be able to build its identity during the World Cup. And that process already is underway.

“To me, it’s another performance where in that first half I saw 11 individuals out on the field trying to play a game of soccer,” Heath said. “And then in the second half I saw 11 individuals that came together as the U.S. women’s team to try to win a game.”

Arsenal manager Jonas Eidevall believes the 2023 World Cup should have kicked off earlier in the year.

The tournament is slated to start on July 20, but the packed women’s soccer calendar places the premier tournament just before the start of the next European season. The quick turnaround means little recovery time for players.

Arsenal just confirmed its fourth ACL tear of the season. And while the club is looking at ways to improve, wider change is needed, Eidevall said. In particular, he pointed to the tight schedule as a factor.

“It is very evident from this summer that this World Cup should have been played earlier. It is evident,” he said. “That would have meant the players could finish the season, have some time off, prepare for the World Cup without so much time off they lose their fitness, they play the World Cup, then there is a gap so they have time off again and then we can start the Champions League qualifiers and the league openers.

“But they didn’t get it right, hopefully in the future they can do it better.”

His concerns echo those of his star forward Vivianne Miedema, who shared her concerns about the workload for soccer players in November – just weeks before she herself tore her ACL.

“I see a worrying pattern. The playing calendar for both the women and the men is simply too full,” she wrote. “Actually, it’s just a shame. We are in a world that goes on and on and there are few players who say anything about it. I do. We go completely crazy with the tax on football players and football players.”

Miedema took a break in November as a result of her schedule, which saw her play for the Netherlands national team in the Euros last July and then roll right into the beginning of the Women’s Super League season with Arsenal.

The calendar has only gotten more hectic in 2023.

Eidevall pointed to this summer’s schedule, noting that if Arsenal were to finish third in the WSL this season, they would enter into the Champions League qualifying round just 16 days after the World Cup final.

“That shows how bad the calendar is. We want to try to finish as high as possible in the table, we want to try to go into the Champions League and we need to do whatever necessary to get there,” he said. “But it highlights a very important issue, if you want to protect players and you want to have importance for the World Cup and the Champions League, but it is impossible for the clubs who are going to play in that playoff round.

“I think there are also qualifying rounds that happen during the World Cup. It really highlights the issues with the calendar, where really important stakeholders like UEFA and FIFA can’t schedule tournaments better to allow players time off.”

Recent reports have indicated that English clubs are pushing back at national teams’ World Cup preparations and will opt to release their players just 10 days before the tournament. The European Club Association has cited the increase in injuries and a concern about player welfare, with a goal to give players more rest time following their club seasons.

Many national teams had planned to start their training camps in mid-June, with the intention of traveling to Australia and New Zealand in early July to give their players time to get acclimated before games begin.

“There are bits that I think clubs can solve internally but there are a lot of things that require the whole world of football to cooperate, we need to do both,” Eidevall said. “Some parts are internal and things we can control, then there are things we need external cooperation with.

“For example, the playing schedule or the cooperation between clubs and national teams or how and when competitions are played and how the international match calendar is done. That requires governing bodies, clubs and national teams working together.”

Arsenal have suffered another blow, as Laura Wienroither has become the fourth player on the squad to suffer an ACL tear in the last six months, the club announced Thursday.

She suffered the injury during Monday’s Champions League semifinal loss. The 24-year-old Austria national team player joins Leah Williamson, Beth Mead and Vivianne Miedema on the Gunners’ roster of ACL injuries this season.

“I’m going to miss every single second of not being on the pitch with this special team,” Wienroither said in an Instagram post. “I’m so proud to be a part of this group and to share experiences with these girls — on and off the pitch.

“I’ll fight like hell to return as soon as I’m ready to get back to following my dream in red and white. This team is really special… I think we can all feel it. Until that time, I’m Arsenal and Austria’s biggest fan.”

Miedema, who tore her ACL in December, posted in support of her teammates: “At least we will all be in the gym together.”

But she also added: “ACL group is full now. Please no more.”

View this post on Instagram

A post shared by Vivianne Miedema (@viviannemiedema)

A number of the game’s biggest stars have suffered ACL injuries in recent months, leading to concern over what many regard as an injury crisis in women’s soccer. Mead has called for more research into injuries in the women’s game, and Portland Thorns forward Janine Beckie – who is also sidelined with an ACL tear – echoed those sentiments and called for more resources for women’s teams.

Earlier this season, women’s health specialist Dr. Emma Ross told Sky Sports that women athletes “are up to six times more likely to have a non-contact ACL injury than their male counterparts.”

She added that just 6% of studies in sports and exercise science are done solely on women, which translates into a lack of research and education on women’s injuries.

While some researchers attribute the injury crisis to the physiological affects of the menstrual cycle, including joints becoming less stable during the cycle, there is not enough evidence to draw a link between the menstrual cycle and injuries, Ross said.

“So we do have some information about loose joints,” she said, “but what we don’t have is the end step of whether that really does increase the risk for injury in female athletes.”

Dr. Katrine Okholm Kryger pointed to soccer cleats being geared toward men’s feet as an injury risk factor, as men’s and women’s feet differ in shape and volume. Many cleat manufacturers have begun to develop a women’s specific cleat, which should be available for this summer’s World Cup.

Aresenal is in the midst of its own internal review after its spate of ACL tears, manager Jonas Eidevall said following Wienroither’s injury. Eidevall also called for external cooperation between clubs, national teams and their governing bodies.

“We need to look at the complete picture and see which factors we can control,” he said. “We need to look at that internally to see what we can do better in the future. Some parts are internal and things we can control, then there are things we need external cooperation with. For example, the playing schedule or the cooperation between clubs and national teams or how and when competitions are played and how the international match calendar is done.

“There are bits that I think clubs can solve internally but there are a lot of things that require the whole world of football to cooperate, we need to do both.”

The Netherlands women’s national team suffered a blow to its 2023 World Cup hopes as star striker Vivianne Miedema went down with a torn ACL.

The injury, which she sustained last Thursday while playing for Women’s Super League club Arsenal, adds her name to the long list of top players who have suffered knee injuries this year.

In a statement Monday announcing the nature of her injury, she ruled herself out for next summer’s World Cup, which is just 213 days away.

“I won’t be able to help my team anymore this season, no World Cup, surgery and rehab for a long time,” she said.

Miedema is the all-time leading scorer for the Netherlands women’s team, with 95 goals in 115 international appearances. This year, she had 10 goals through 11 appearances; in 2021, 15 goals in 13 appearances.

Vivianne Miedema heeft een zware knieblessure opgelopen en is voor langere tijd uitgeschakeld. Heel veel sterkte, Viv! 🧡 pic.twitter.com/8DZjbrvmpY

— OranjeLeeuwinnen (@oranjevrouwen) December 19, 2022

She played a big role in the Netherlands’ run to the World Cup final in 2019, scoring three goals in the tournament. Just one other Dutch player, Lieke Martens, scored more than one goal in the tournament, in which the Netherlands fell to the USWNT in the championship match.

Miedema’s absence could create more problems for the Netherlands than just a hole in their offense. She also provides a veteran presence for a team that has undergone many changes since that 2019 run.

In 2021, manager Sarina Wiegman departed for the England women’s national team. Mark Parsons succeeded her in the position, but his tenure was short-lived. The team crashed out in the quarterfinals of the Euros in July, and Parsons and the team parted ways soon afterward.

“In the run-up to and at the European Championship, both the games shown and the results were disappointing and we cannot afford that,” KNVB board member Jan Dirk van der Zee said. “The bar is high. The Netherlands was defending champion and also a finalist at the last World Cup, we want to participate for the prizes.”

The issues with Parsons, though, seemingly run deeper than the Euros run. When Danielle van de Donk was asked after the Euros loss what she had learned with Parsons at the helm, she said she would “think about that.”

In his place, Andries Jonker was named head coach. He’ll lead the team in the World Cup in a group that includes the USWNT and Vietnam.

The quarterfinal loss in the Euros had marked the return of Miedema, who missed most of the tournament with COVID-19. She later wrote about the difficulties of the tournament, including playing the full 120 minutes in the quarterfinal against France after she had spent days in bed with a fever.

That tournament became the catalyst for Miedema’s decision to take a step back from the pitch in November, but she had come back rejuvenated before she suffered her ACL injury.

Vivianne Miedema has ruptured her ACL, she announced Monday, adding her name to the growing list of top-tier players who have torn knee ligaments.

“Absolutely gutted to share I’ve ruptured my ACL in our last game against Lyon,” Miedema wrote. “It was one of those moments where I knew straight away.”

The striker, who stars for Arsenal and for the Dutch women’s national team, did not provide a firm timeline for her recovery. But she said it would be “a long time” before she would return to the pitch, and she ruled herself out for the 2023 World Cup.

“I won’t be able to help my team anymore this season, no World Cup, surgery and rehab for a long time,” she continued. “I won’t be telling you I’ll come back stronger or that I’m looking forward to spend the next however many months in the gym.

“It will be tough with plenty of difficult days (plenty of crying, which we’ve had a lot of already), but sadly enough it’s part of football.”

💔🤕🩼

Gutted to share I’ve ruptured my ACL.

-

PS. I can’t wait to boss around @bmeado9 this time, at least we’ve still got two decent ACL’s between us 🩼😅 pic.twitter.com/E52GAQP1GI

— Vivianne Miedema (@VivianneMiedema) December 19, 2022

Arsenal said in a statement that Miedema will undergo surgery “in the coming days.”

“[She] will unfortunately be ruled out for an extended period of time. A more detailed timescale will be established once the operation is complete,” the Women’s Super League club said. “Everyone at Arsenal wishes Viv well in her recovery and will be providing her with all the support she needs to return to action as soon as possible.”

Miedema joins her girlfriend and Arsenal teammate Beth Mead on the ACL injury list. Miedema suffered her injury last Thursday during Arsenal’s Champions League match against Lyon and had to be stretchered off the field.

With the Dutch star’s injury, 25 percent of the 2022 Ballon d’Or Féminin nominees are sidelined with ACL injuries, including winner Alexia Putellas. The USWNT has also been hit hard by ACL injuries, with both Catarina Macario and Christen Press sidelined.

Miedema is one of the top strikers in the game, having scored 78 goals in 97 league appearances for Arsenal.

She just recently made her return to the field after taking a break in November. Upon her return, she went on a tear, scoring four goals in four games to help Arsenal to second place in the Women’s Super League standings.

Miedema has been vocal in criticizing the packed playing calendar as a contributing factor in the recent rash of injuries. On Saturday, FIFA announced that it will be adding even more to the women’s calendar, introducing a women’s Club World Cup in 2025.

Vivianne Miedema became the latest top women’s soccer player to sustain a knee injury, as the star striker left Arsenal’s Champions League match Thursday on a stretcher.

The 26-year-old went to the turf after she landed awkwardly on her left leg in the first half of the 1-0 loss to Lyon. Before the injury, she had been on a tear, scoring four goals in four matches for the Gunners.

“I have no information at all yet,” Arsenal coach Jonas Eidevall said after the match. “It’s just the concern I have here now after the game, and that’s where a lot of my thoughts are at the moment to be honest.”

The club has not provided further details on the injury. Miedema is set to see a knee specialist for further evaluation.

🗣 “I have no information at all yet. It's just the concern I have here now after the game, and that's where a lot of my thoughts are at the moment to be honest.”@eidevall on @VivianneMiedema’s injury pic.twitter.com/RlFK926hpl

— Arsenal Women (@ArsenalWFC) December 15, 2022

Miedema had taken a break from the sport in November to rest and recuperate. The Dutch star had credited the step back from the sport with her rejuvenated play since her return.

Also since her return, she had been vocal about the need for rest, for herself and for all athletes.

Miedema contracted COVID-19 this summer, which kept her out of several matches at the Euros tournament. After she returned from COVID-19, she jumped straight into training for the Women’s Super League season.

“I just didn’t feel mentally and physically ready to actually play,” she said. “I think you could see that in the way that I was playing. I didn’t enjoy my football at that moment.”

She called out the packed soccer calendar as a possible contributing factor in player injuries in a column for Dutch newspaper AD in November.

Also in November, U.S. women’s national team fitness coach Dawn Scott raised the alarm over ACL injuries in women’s soccer in particular. Players who have injured their ACLs in 2022 include: USWNT’s Tierna Davidson, Catarina Macario and Christen Press; Germany’s Dzsenifer Marozsán; France’s Marie-Antoinette Katoto; Spain’s Alexia Putellas; Australia’s Ellie Carpenter; Brazil’s Marta; and Denmark’s Nadia Nadim.

Miedema’s Arsenal teammate and girlfriend, Beth Mead, joined that list when she ruptured her ACL in November. She likely will miss the 2023 World Cup as a result.

Vivianne Miedema, a nominee for the Ballon d’Or Féminin this year, criticized the global soccer awards ceremony for its treatment of the women’s game.

The Arsenal and Dutch striker called attention to the disparity between the number of men’s players honored at the event versus the number of women. Of the seven awards handed out at the Ballon d’Or, only one represents women’s soccer. Spain and Barcelona midfielder Alexia Putellas won the award recognizing the best player in the international women’s game in 2022 for the second straight year.

“I didn’t feel appreciated as a woman footballer there,” Miedema told BBC’s “Behind the Goals” podcast. “If they want to have women involved, they have to do it in a different way. They had five or six different awards for the men’s game while the women only have one. If they want to make it equal, they have to give the same awards to men’s and women’s football.”

Miedema attended the event in October with her partner, England striker Beth Mead, who finished as runner-up to Putellas. A photo of the two on the red carpet together circulated after the event with a caption describing Mead as Miedema’s “guest.”

The 26-year-old joked about the mistake on Twitter at the time but said on the podcast this week that it reflected the overall lack of respect for the women athletes.

“Waking up the next morning and that picture pops up, that states the issue we had the night before,” she said. “We’ve got the number two from that year, who should arguably have been number one, turning up to the event as ‘my guest.’ That would obviously never happen if [Lionel] Messi and Neymar had been walking next to each other.

“We obviously joke about it, but that shows there are so many improvements to be made. It needs to be organized so much better.”

Miedema is the all-time leading scorer for the Netherlands across both the men’s and women’s teams. Since returning to Arsenal this season from a mental and physical break, she has scored four goals in four games to lift the Gunners to second place in the WSL table and first place in Group C of the Champions League standings.