Tottenham Launches Review into Season-Long Fitness Issues, Focusing on ACL Injuries

Tottenham have launched an extensive review into why their season was heavily affected by fitness issues, with a key focus on the "unusual" spate of anterior cruciate ligament injuries. Spurs avoided relegation on the final day of the season thanks to a 1-0 win over Everton but their difficult campaign was beset by a constant flow of injuries to key players. The club are now carrying out an internal audit - led by performance director Dan Lewindon, who joined the club from the City Football Group earlier this year - to work out why their season was so badly disrupted. It is understood the average availability of Spurs players last season was about 77%, and squad members were absent for a combined period of more than 2,000 days. Tottenham would prefer to take those numbers closer to 90% availability and fewer than 1,000 days, though there is an acknowledgement that may be difficult to achieve in the months leading up to next season. James Maddison, Wilson Odobert and Xavi Simons all sustained long-term ACL injuries, while Dejan Kulusevski missed the entire campaign after requiring surgery on a serious knee injury from the end of the 2024-25 season. There has been an acknowledgement among medical staff at Tottenham that the club have sustained more ACL injuries than they should. As part of the audit, they are considering numerous factors to work out why it has become such a problem. For example, Spurs are analysing the "bounce" on the club's home pitch in comparison to that at rival grounds and their Enfield training centre. At present, the club have found there is no major difference between the conditions of other pitches in comparison to their home ground, but testing is ongoing. There is a view that certain knee injuries are unavoidable - Odobert for instance damaged his ACL following an awkward landing. It is also understood Spurs are confident the on-field treatment of Simons' injury did not result in additional damage to the Dutchman's knee. There has been criticism from supporters after footage showed medics allowing the attacker to put weight on his knee despite having suffered a serious injury. One of the key improvements Lewindon has recommended is to make medical support more individually tailored - based on factors including strength, fatigue and robustness. Medical staff will compile bespoke profiles for each player that will include personal insights as well as physical and psychological information to ensure they can deliver expert individual support to treat - but also prevent - injury. There is also set to be greater leeway for injured players to conduct part of their rehabilitation away from the club's training facility. Players across the Premier League are increasingly relying on external medical practitioners to aid their fitness and recovery, while many overseas footballers even return to their homeland for treatment. That dynamic often causes friction but moving forward Tottenham are open to letting players leave their direct care provided all parties involved agree to one shared recovery plan - though Spurs would ultimately take responsibility for any problems that arise during the process. The medical team will work closely alongside head coach Roberto de Zerbi and his staff over the summer amid concerns changing managers three times in under 12 months has contributed to their injury problems. Tottenham will look to introduce an integrated structure that will ensure De Zerbi, or a member of his staff, the medical department and the player are involved in deciding when a player can accelerate their rehabilitation plans. Psychology is also a key component of the ongoing review with the club set to employ a full-time head of psychology to work with the players and staff.