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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.

Captain Ben Davies has returned from a serious ankle injury to be included in Wales' squad for friendly matches against Ghana and Romania, while Connor Roberts could make his first competitive appearance for a year.

Tottenham Hotspur defender Davies, who turned 33 last month, has not played since sustaining the injury, which required surgery, while playing for his club in January.

Burnley right-back Roberts has been absent since injuring himself during Wales' World Cup qualifying defeat by Belgium in June 2025.

The 30-year-old was forced off with a groin injury in Brussels, before damaging his Achilles after returning to Burnley, ruling him out of the entire 2025-26 season.

Having featured for the Clarets' Under-21s earlier this month, Roberts returned to the first-team matchday squad for the first time this campaign on Sunday as he was an unused substitute for the Premier League draw with fellow relegated side Wolves.

There is also a return from injury for centre-back Chris Mepham, but midfielders Jordan James and Rubin Colwill as well as forwards Liam Cullen and Mark Harris miss out with minor injuries.

Wales host Ghana, one of England's World Cup group opponents, at Cardiff City Stadium on Tuesday, 2 June, before facing Romania in Bucharest the following Saturday.

Watch former Tottenham goalkeeper Joe Hart analyse Cristian Romero's future, with the Spurs captain heavily linked with a move away this summer despite their final day survival.

"I think he'll move himself on," Hart told BBC Radio 5 Live's Monday Night Club.

"I think it's been really difficult and the hardest thing for me to watch is in big moments he's not been able to control his emotions.

"I was at Old Trafford and I remember Tottenham starting well and then he lost the ball in a moment where he feels he shouldn't and because of that a switch went in his head and he nailed someone over the ball. Red card in such an important game.

"I couldn't imagine that guy leading me. There's no doubt he's a brilliant player and you can't take that emotion out of him. But to put that at the forefront of it and let him do his thing, I think is a really difficult one for Spurs."

Tottenham forward Mohamed Kudus will miss next month's World Cup because of injury after being left out of Ghana's preliminary 28-man squad named by Carlos Queiroz.

Kudus was expected to return in March from a quad injury suffered in January but suffered a setback and has not featured since.

Now the curtain has come down on the 2025-26 Premier League campaign, here is my end-of-season review - with a look back to what I predicted in August.

Prediction: 8th

As big a shambles as it is possible to imagine - on and off the field. Reduced to celebrating Premier League survival on the season's final day with victory over Everton.

The job proved too much for Thomas Frank, who found the expectations and dysfunction of Tottenham a sharp contrast to the stability of Brentford.

Just when you thought it could not get worse, matters hit a new low with the bizarre appointment of Igor Tudor, an arrival that posed serious questions of CEO Vinai Venkatesham and sporting director Johan Lange.

Tudor lost five of his seven games before he left after 44 days, to be replaced by Roberto de Zerbi.

Spurs escaped at the 11th hour, but it was a reprieve borne of luck more than judgement.

What I said in August: "It could not get worse than last season - or Spurs would find themselves in the Championship."

Tottenham say "football success had not been driving our decisions" as non-executive chairman Peter Charrington admitted failings and vowed to rebuild in an open letter to the club's supporters.

Spurs narrowly avoided relegation with a 1-0 win against Everton on the final day of the Premier League season, finishing 17th for the second season in a row after a difficult campaign that Charrington said fell "well short" of expectations.

"Last September, we recognised that something seismic had to change at Spurs," wrote Charrington, who was appointed to the Spurs board in March 2025.

"The Lewis family stepped in and authorised a full reset. That decision was not taken lightly, and it came later than it should have."

That reset coincided with Daniel Levy stepping down after nearly 25 years as executive chairman, with sources indicating the decision was taken to improve sporting performance.

"As part of that process, we discovered some uncomfortable truths," Charrington added.

"The qualities that make Spurs distinct, our football, our ambition, the connection between the team and its supporters, had been allowed to fade. Football success had not been driving our decisions.

"We did not have the right expertise in key roles. We did not build squads good enough to compete in the most demanding league in the world."

Charrington was in attendance at the Tottenham Hotspur Stadium for Sunday's season finale along with Vivienne Lewis, representing the family who own Spurs, her son-in-law Nick Beucher and the club's finance officer Matthew Collecott.

Now under manager Roberto de Zerbi, Spurs needed a point on the final day to avoid their first relegation from the top flight since 1977 - and only a third home league win of the season ensured they sent West Ham down instead.

Charrington added that Spurs have since restructured their football operations, with refreshed executive and football teams, as well further appointments expected in the coming weeks.

The chairman also backed De Zerbi, who signed a five-year contract when joining in March, "to build back to where we need to be", saying the Italian "represents the kind of football and ambition that Tottenham should stand for."

It comes after Spurs midfielders James Maddison and Conor Gallagher credited De Zerbi, who became the club's third manager this season after Thomas Frank and Igor Tudor, with saving the club from relegation.

"Without that appointment, disaster could have maybe struck, but it didn't and he takes a lot of credit for that because of the work he's done behind the scenes and on the training pitch," Maddison said.

Gallagher added: "From the first day or two he had everyone under his wing. Everyone trusted him instantly and everything he was doing - it was like 'thank God he's come in' straight away."

Tottenham midfielder James Maddison says he is "really happy" for "passionate" head coach Roberto de Zerbi, without whom the season could have ended in "doom and gloom".

De Zerbi took charge at the end of March with Tottenham winless in the Premier League in 2026 and in the relegation zone before his first match.

However, despite injuries to key players, including Cristian Romero and Xavi Simons, he bought a renewed positivity to win three out of Spurs' final five games and stay up on the final day.

"He's so passionate," said Maddison, who has only recently returned from a long-term knee injury.

"He's been living at the training ground with the guys, with his team.

"He's there at 9pm with all his staff. They've got the tactics board up, there's six of them, they're just talking. It's 9pm and we've already had four or five meetings on each game. He's just obsessed with football.

"You feel the authenticity of someone who's passionate for Tottenham - because I am, I love this club and I want this club to be successful so badly.

"Without that appointment, disaster could have maybe struck, but it didn't and he takes a lot of credit for that because of the work he's done behind the scenes and on the training pitch.

"I'm excited under this manager."

Another player invigorated by De Zerbi's arrival was Conor Gallagher, who looked lost in his first few games after his January move from Atletico Madrid but has been a key performer in getting Spurs over the line in the final stretch.

"He completely turned around the start of my Spurs career," Gallagher reflected.

"From the first day or two, he had everyone under his wing. Everyone trusted him instantly.

"I can't speak highly enough of him."

Travelling across a sweltering London to Tottenham Hotspur Stadium by Tube on the final day of the season, the emotional divide among football fans in the city was striking. Sitting opposite me in the carriage, a man in his 50s wearing a 90s original "Holsten" home shirt was wedged between two Arsenal supporters.

"I think you'll be all right today, mate," they offered.

Now I know you don't speak to strangers on the Tube if you're a Londoner, but this Spurs fan just stared straight ahead, entirely consumed by the dread and anxiety that they could be relegated on the same day that Arsenal were crowned champions. He didn't even acknowledge them.

There was a hush around the ground on arrival - very few smiles, very little noise. That was until the team bus turned up and the players were greeted as if it was them that had won the Premier League title and not their north London rivals.

Inside the ground, the wall of noise before kick-off was deafening. The relief at Joao Palhinha's goal palpable. The West Ham goals against Leeds filtered through to add some jeopardy, but Everton never really offered enough until late on to make it truly nerve-wracking inside the stadium.

Spurs' players collapsed with a mixture of exhaustion and relief at the final whistle, and the South Stand became a wall of noise once again.

The concourses, now doubling as bustling bars, were now buzzing - smiles, laughter, singing, drinking and general merriment.

The journey home saw the Victoria Line trains mixed with red and white shirts as triumphant Arsenal fans returned from south London to launch an impromptu street party around Emirates Stadium. Fans chanted at each other as they passed on the escalators, but what I saw was good humoured.

It was one city and three entirely different sets of emotions for the supporters of the teams involved on an afternoon in the capital not to be forgotten.

De Zerbi couldn't wait to see one journalist

De Zerbi couldn't wait to see one journalist

Tottenham Hotspur manager Roberto de Zerbi could not wait to see one journalist after confirming their place in the Premier League next season with a 1-0 win against Everton on the final day.

Former captain Gary Mabbutt hopes Ben Davies will have a future at Tottenham Hotspur after the club avoided relegation to the Championship.

Wales skipper Davies, who turned 33 last month, sees his Tottenham contract expire next month.

The defender has not played since suffering a serious ankle injury in January, but Mabbutt believes he should be offered the chance to stay at a club he has represented for 12 years.

"Ben's a great lad," said Spurs great Mabbutt.

"What he has given to the club so far… it was just so unfortunate the injury he received. It was devastating for him and or us because Ben's a player you can always rely on.