Brazil have confirmed that Neymar will undergo surgery after he ruptured the anterior cruciate ligament (ACL) and meniscus in his left knee.
The 31-year-old had to be taken off on a stretcher during the first half of Brazil’s 2-0 loss against Uruguay in Montevideo and was replaced by Tottenham’s Richarlison.
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Scans have since revealed the extent of Neymar’s injury. His club, Al Hilal, confirmed that “he will be going through surgery and then a treatment program that will be determined later”.
Neymar only recently recovered from a long-term ankle injury that sidelined him during his time at Paris Saint-Germain. He then joined Al Hilal in Saudi Arabia during the summer and played five matches before the international break, scoring one goal.
Neymar wrote on Instagram: “It’s a very sad moment, the worst. I know I’m strong but this time I’m going to need my family and friends even more. It’s not easy to go through injury and surgery, imagine going through it all again after 4 months of recovery.”
The forward will face a race to be fit for the 2024 Copa America, which takes place in the United States between June 20 and July 14. Recovery from an ACL injury can take between six months to over a year.
Brazil finished as runners up to Argentina during the 2021 tournament.
Brazilian Football Confederation (CBF) president Ednaldo Rodrigues added: “Brazilian and world football needs Neymar well and recovered, because football is happier when he is on the field.
“Neymar can count on my friendship and also on all the support of the entity.”
Neymar has seen the last three seasons disrupted by injury. The forward was sidelined for three months during the 2021-22 campaign with an ankle injury, before another ankle injury ruled him out of two Brazil matches at the 2022 World Cup. He returned to action for PSG before sustaining ligament damage on the same ankle in February and subsequently undergoing surgery, forcing him to miss the final four months of the season.
What is an ACL?
There are two central ligaments in a knee: the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL).
The ACL is key for athletes who need to change direction as it allows control of rotation. Imagine the ligament is like a piece of rope with multiple fibres in it.
When it ruptures, all those fibres break and it’s like a rope that has been split into two pieces. It is possible to have a partial tear but it’s actually really rare; almost all are complete ruptures.
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How long could Neymar be out of action for?
Speaking to The Athletic in February, consultant knee surgeon Andy Williams said on ACL recovery time: “My average return to play is about eight months for a pure ACL.
“It is longer if other structures, such as ligaments and/or menisci are involved, or if complications occur. People talk about six months, but actually, it’s usually a bit longer.
“From about four months, you can do some on-pitch training but we try to get people into more natural function as early as 10 weeks.”
Will Neymar’s age be a significant factor in his recovery?
The Brazilian is 31, and will turn 32 in February, part way through his rehabilitation period.
“For sure, the biological age of the athlete can factor,” says Bill Knowles, perhaps the worldwide authority on ACL injuries. “The more he picks up injuries at his age, the more he continues to become what I term a ‘joint compromised athlete’. That doesn’t have to end his career, but it can alter his career path.”
However, he adds the significant caveat that this isn’t true across the board.
“For someone like Neymar who is so elite and world class, he has every opportunity to come back from this extremely well. I would always go into these things very optimistic, and I just wouldn’t be using the age card on him right now.”
What about his previous injuries?
This is perhaps more significant. Neymar has not suffered a significant knee injury before, but he has been beset by ankle problems: he missed large chunks of last season after undergoing ankle surgery, and has been ruled out in previous years with similar issues too.
“The concern is not just how he returns from a healed ACL and healed meniscal repair, and whether or not he gets his muscles strong,” says Knowles. “That’s actually very easy to do.
“Injuries to the knee and ankle are local injuries. But what they have is a central consequence – and the central is the brain. This central consequence influences the coordinative abilities, or the timing and sequencing of dealing with forces. It’s what we call a neurophysiological insult to the brain.
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“This neurophysiological insult – it takes time to improve or correct. It can be 18-30 months, where the brain is slowly trying to restore 100 per cent function again.”
Knowles likens this to a dimmer switch for a light: it doesn’t just switch on and off, but gradually goes up and down. Elite athletes, as well as being physically on another planet to the rest of us, are usually wired very differently in their brains, which makes it easier for them to recover from serious injuries.
But all of this can have a significant knock-on effect on how a player recovers.
“If they sustain an ankle injury, let’s say in the first year after coming back from an ACL, they have an increased risk or threat to either re-injuring the same knee, or potentially injuring the second knee. Even if it was an ankle injury.
“And likewise, an ankle injury has the ability to tell your muscles – even in your hip – to switch off and get a bit sleepy. Even your core.
“It’s the most important discussion going on today. The restoration of this neurophysiological insult is the most important thing to protect the athlete in the future.
“An old adage I’ve been saying for over 30 years: it’s easy to get athletes back, it’s harder to keep athletes back, after a long-term injury.”
GO DEEPER
What is an ACL tear and how long does it take to recover?
(Top photo: Guillermo Legaria/Getty Images)