Picking over the bones of what Leah Williamson’s anterior cruciate ligament injury means for England feels brutal. Cruel even. Because, in reality, none of it matters. Where Arsenal finish in the league and Champions League doesn’t matter, whether England win the World Cup doesn’t matter. In this moment all that does matter is that a 26-year-old footballer in her prime has had to let short-term dreams die to embark on a mentally and physically bruising journey. “The noise around the situation is loud and I need some quiet to let it all sink in,” said Williamson on Instagram after the extent of her injury was announced. Yet, here I am, adding to the noise. Hopefully Williamson never sees this article, hopefully she is switched off from the outside world and being engulfed in the embrace of the tight unit of friends and family that mean more to her than anything else. Williamson knows how to contextualise the sport she plays; she has demonstrated that time and again in interviews. She says it explicitly in her social media post: “In the past couple of years alone I have watched teammates beat serious illnesses and adversity with the biggest of smiles on their faces. I also hold perspective that globally there are much greater difficulties and therefore my circumstances right now are just that, circumstantial, and I’ve seen a lot worse.” The perspective helps remind you that it all doesn’t really matter. But it also really does. On a personal level it’s her career, her joy, her structure but on a wider level it’s our joy, our release, our hopes, our game. Arguably, such is Williamson’s influence and importance, the absence of the England captain is the difference between England winning the World Cup or not. That is a huge cross to bear in addition to her own personal disappointment. One that will weigh heavy with each mention of her name that will inevitably grace every commentary, match report and analysis in and around the tournament. Williamson may still go to Australia in July. When interviewing her for her book she told me that she always prepares to distract from disappointment, that her parents would book trips away or fun things to do around squad announcements when she was younger so that if she didn’t make the cut, she would have something to look forward to anyway. Her younger brother is playing football in Australia and her going to spend time with him was on the cards if things didn’t work out. That backup plan may need to change now there is surgery and rehabilitation ahead, but the mindset likely remains the same for an individual who has spent a lot of time working on how she copes mentally in times of adversity. Coping without Williamson will be extraordinarily difficult for England. Not only does the team lose their incredibly articulate captain, who has become an impressive mouthpiece for a squad with a desire to use their platform for good, they lose a critical player on the pitch. Confirmation on Friday that Williamson’s fellow centre-back and vice-captain Millie Bright has avoided an ACL injury will be extremely welcome to Sarina Wiegman. But there must be concern for the England manager that her Chelsea counterpart, Emma Hayes, said Bright would be “out for weeks, I can’t say how many” after having “a bony cartilage lesion” cleaned out of her knee. The most likely pairing at the back for England, in Williamson’s absence, becomes Bright and Manchester City’s Alex Greenwood, but behind them in line sit a number of players with few caps in Maya Le Tissier, Esme Morgan, Lotte Wubben-Moy and Lucy Parker. Jess Carter, who can play at centre-back, has been commandeered to play on the left with Euro 2022 left-back Rachel Daly shifted into her preferred centre-forward role. Williamson’s absence also deals a blow to the depth in midfield given that she was the natural choice to step in should something happen to the somewhat irreplaceable defensive midfielder Keira Walsh – a role she has played a number of times for club and country. Williamson’s is just the latest name on a lengthy list of players to be missing the World Cup. England will be poorer for it, the World Cup will be poorer for it and the news will once again spotlight the lack of research into an injury that women are up to eight times more likely to suffer. Hayes said on Friday that she was “devastated” to hear of Williamson’s injury but added that “we need to stay away from lazy assumptions [on ACL injuries] – the reasons are multi-faceted”. She is right. There are so many contributing factors: different biomechanics and the strength and conditioning implications of that, inconsistency in the footballing calendar, small squad sizes, not enough coaching and medical staff, inadequate facilities and equipment, football boots not designed for women’s feet, poor pitches, players not having been trained and conditioned for three games a week from a young age, and more. Critically, there is not enough research specific to women’s bodies relating to all of this. Some of that work is happening now. The European Club Association’s women’s high performance advisory group is one of those funding extensive research into ACL injuries. Future players have hope of limiting their chances of sustaining the long-term injury, but current players, such as Williamson, will continue to suffer the consequences of decades of neglect in the meantime.