Anterior cruciate ligament (ACL) knee injuries can follow the same pattern.
The initial blow, the minutes spent in the immediate aftermath trying to walk on the damaged leg, thinking things might be and then, once the early shock has subsided, the shattering realisation that they are not.
In the 63rd minute of Aston Villa’s 2-1 defeat against Manchester United on Sunday, Boubacar Kamara rode that grim emotional rollercoaster.
After attempting to close down Casemiro, Kamara turned quickly and collapsed to the ground, immediately clutching his right knee. He clenched at the bones peering out from the top of his sock, frightened to move.
As the television coverage switched to various highlights due to the stoppage in play, Kamara’s initial pain, at least, appeared to lessen. He was helped back to his feet by two physios and tried to walk without support to the touchline, despite head coach Unai Emery readying Moussa Diaby to replace him.
Kamara shuffled gingerly to the technical area, without assistance and, crucially, hopping on his right leg, as if trying to test whether weight could be put on it.
Privately, there was hope from those close to Kamara that the pain in his knee would not be overly serious and to the naked eye, the extent of the injury did not appear as cataclysmic as scans revealed less than 24 hours later.
Just after 5pm UK time on Monday, The Athletic confirmed Kamara had ruptured the ACL in that knee, ruling him out for the remainder of the season and ending any hopes he had of making the France squad for this summer’s European Championship. Early projections state the 24-year-old will miss the next five to six months after undergoing surgery in the coming days.
Kamara’s absence adds to the fatalistic sense converging on Villa. Staggeringly, he is the third player in the squad to suffer an ACL injury this season alone, after it happened to Emiliano Buendia and then Tyrone Mings within four days of each other in August.
In some ways, Villa’s achievements so far this season are all the more remarkable when you consider the unrelenting catalogue of injuries they have had to deal with. Emery has not had his first-choice XI for a single match, with players’ unavailability complicated and compounded by reoccurring injuries to a number of key personnel.
Alex Moreno, Pau Torres and Jacob Ramsey — Emery’s entire preferred left side — have all returned to training at some point before suffering another setback related to their prior injury.
Ezri Konsa, Villa’s most well-rounded defender, had to be replaced in the 5-0 victory over Sheffield United on February 3. Konsa played the most Premier League minutes of any outfield player in the calendar year 2023 (3,732 – the equivalent of 41 matches) and while Emery, somewhat optimistically, suggested he would be out for “three to four weeks” with another knee injury, the present feeling is more ominous.
Right now, Emery is without his three best centre-backs in Konsa, Mings and Torres.
Knee injuries, reoccurring setbacks and general misfortune threaten to undermine Villa’s aspirations this season, both in the Europa Conference League, where they play in the last-16 next month, and finishing in the top four/five of the Premier League. Winter transfer window departures have further weakened a threadbare squad short of depth in key positions.
History is not kind to paper-thin teams trying to compete among the elite and across more than one front.
Kamara is Villa’s latest victim and arguably the biggest blow. Plainly, Emery does not have another player like him. Without Leander Dendoncker, a high earner but a mixed performer, who left for Napoli on loan last month, Villa lack an alternative defensive-minded midfielder, adept in anchoring central areas.
“I’m very happy, and his potential is really high,” said Emery last month, talking about the former Marseille academy graduate. “When I am speaking with different people around football and about our players, one of them having a good impact is Kamara.”
Emery is a huge advocate of Kamara because of his necessity to Villa’s overall framework. In possession, he is the chief cog in progressing the ball from deep, often dropping into a third centre-back position and giving license to the full-backs to occupy areas high and wide.
This is especially relevant in breaking down low blocks, as it squeezes Emery’s two No 10s inside and allows Villa to operate with more bodies in advanced areas and covering the width of the pitch, as illustrated here in September’s 3-1 home win against Crystal Palace.
Kamara often receives the ball in precarious positions on the pitch, with opposition pressure threatening to engulf him and having to decide on the next move quickly. This does mean he occasionally runs into trouble buthis team-mates and Emery view mistakes as a by-product of playing in the riskiest position on the pitch. Their trust in him is total.
“The characteristics of Kamara are very important,” said Emery. “He’s progressing and he’s improving a lot. He’s humble. He’s young but very responsible. He’s very positive, every day, to improve. He listens a lot. He’s always ready to work and his potential is getting better.”
Without the ball, Kamara’s positional awareness guides Villa’s “rest defence” — ensuring the team can apply immediate pressure once they lose the ball and prevent potentially dangerous counter-attacks — and gets him into areas to stop transitions. The decision on Sunday to challenge Casemiro, where he ultimately sustained the injury, was a case in point of him counter-pressing.
Villa are becoming hamstrung in their attempts to break through the Premier League’s glass ceiling and qualify for the Champions League. It has perhaps gone unmissed by the wider public, largely due to how well they have managed, that injuries have beset the club all season. However, it is only now that such persistent knockbacks are having a discernible and damaging effect.
John McGinn has been operating as the support striker to Ollie Watkins within Emery’s 4-2-2-2 shape but will likely move deeper alongside Douglas Luiz to compensate for Kamara’s absence. McGinn is trusted more than Youri Tielemans to provide greater defensive security but is by no means the ideal solution.
Academy graduate Tim Iroegbunam has been namechecked on several occasions by Emery but has only played 25 first-team minutes this season across all competitions. The 20-year-old lacks the experience to step into such a critical position and a system facing this much adversity.
In truth, Kamara’s injury creates a hole no player at the club can truly fill. It is again up to Emery to adjust and overcome this latest setback in Villa’s sequence of bad luck this season.
(Photo: Catherine Ivill/Getty Images)