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Annibaldi A, Monaco E, Carrozzo A, Caiolo V, Criseo N, Cantagalli MR, Ferretti A, Maffulli N. Return to Soccer After Acute Anterior Cruciate Ligament Primary Repair: A 2-Year Minimum Follow-up Study of 50 Amateur Players. Am J Sports Med 2024:3635465241256099. [PMID: 38868946 DOI: 10.1177/03635465241256099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. PURPOSE To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. RESULTS The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). CONCLUSION In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.
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Affiliation(s)
- Alessandro Annibaldi
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Alessandro Carrozzo
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Vito Caiolo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Natale Criseo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Matteo Romano Cantagalli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
| | - Nicola Maffulli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Manojlovic M, Ninkovic S, Matic R, Versic S, Modric T, Sekulic D, Drid P. Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence. Sports Med 2024:10.1007/s40279-024-02035-y. [PMID: 38710914 DOI: 10.1007/s40279-024-02035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR. OBJECTIVE The aim of this systematic review was to examine RTP and the performance of soccer players after ACLR. METHODS Three electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Databases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years. CONCLUSION Although a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.
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Affiliation(s)
- Marko Manojlovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia.
| | - Srdjan Ninkovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Radenko Matic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Sime Versic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Toni Modric
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Piussi R, Simonson R, Zsidai B, Grassi A, Karlsson J, Della Villa F, Samuelsson K, Senorski EH. Better Safe Than Sorry? A Systematic Review with Meta-analysis on Time to Return to Sport After ACL Reconstruction as a Risk Factor for Second ACL Injury. J Orthop Sports Phys Ther 2024; 54:1-15. [PMID: 38032099 DOI: 10.2519/jospt.2023.11977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE: To compare the time to return to sport (RTS) between patients who did and did not suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Cochrane Library, Embase, Medline, AMED, and PEDro databases were searched in August 2021 and again in November 2022. STUDY SELECTION CRITERIA: Clinical studies reporting time to RTS after ACL reconstruction and second ACL injury were eligible. DATA SYNTHESIS: We pooled continuous data (time [months] and proportions [%]), with random-effects meta-analyses. Pooled estimates were summarized in forest plots. A qualitative data synthesis was also performed. RESULTS: Twenty-one studies were included in the meta-analysis and 33 in the qualitative synthesis. Pooled incidence of second ACL injury was 16.9% (95% confidence interval [CI]: 12.8, 21.6). Patients who suffered a second ACL injury returned to sport significantly earlier (25 days; 95% CI: 9.5, 40.4) than those who did not suffer another injury. There was no difference in time to RTS for professional athletes who suffered a second ACL injury and those who did not. The certainty of evidence was very low. CONCLUSION: There was very low-certainty evidence that patients who suffered a second ACL injury had returned to sport 25 days earlier than patients who did not have another injury. For professional athletes, there was no difference in time to RTS between athletes who suffered a second ACL injury and athletes who did not. J Orthop Sports Phys Ther 2024;54(3):1-15. Epub 30 November 2023. doi:10.2519/jospt.2023.11977.
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Lucidi GA, Roberti di Sarsina T, Zaffagnini S. Editorial Commentary: The Number One Cause of Anterior Cruciate Ligament Reconstruction Graft Failure Is a Misplaced Femoral Tunnel: Over-the-Top Technique Plus Lateral Extra-Articular Tenodesis Is Recommended. Arthroscopy 2024; 40:435-437. [PMID: 38296446 DOI: 10.1016/j.arthro.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 02/15/2024]
Abstract
Patient factors (notably high tibial slope and narrow femoral intercondylar notch width) and surgical factors (including meniscus treatment and anterior cruciate ligament [ACL] tunnel position) contribute to ACL reconstruction failure. The number one cause of failure is a misplaced ACL femoral tunnel. Tunnel malposition leads to a higher incidence of postoperative meniscal lesions, inferior clinical outcomes, and higher revision rates.
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Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Roberti di Sarsina
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Pinheiro VH, Borque KA, Laughlin MS, Jones M, Balendra G, Kent MR, Ajgaonkar R, Williams A. Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction. Am J Sports Med 2023; 51:3649-3657. [PMID: 37960868 DOI: 10.1177/03635465231207832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. PURPOSE To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone (P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). CONCLUSION The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.
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Affiliation(s)
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | | | - Ryan Ajgaonkar
- University of Texas Rio Grande Valley Medical School, Edinburg, Texas, USA
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
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Zaffagnini S, Lucidi GA, Macchiarola L, Agostinone P, Neri MP, Marcacci M, Grassi A. The 25-year experience of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: the story so far. J Exp Orthop 2023; 10:36. [PMID: 37005946 PMCID: PMC10067780 DOI: 10.1186/s40634-023-00599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
This article presents with an evidence based approach, the kinematical rationale, biological evidence and the long term results of the "Over-The-Top" anterior cruciate ligament reconstruction with lateral plasty technique. This surgery was developed more than 25 years ago at the Rizzoli Institute by professor Marcacci and Zaffagnini and it is still widely performed in many orthopedic center worldwide.
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Affiliation(s)
- Stefano Zaffagnini
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Luca Macchiarola
- Ortopedia E Traumatologia, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Piero Agostinone
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy.
| | - Maria Pia Neri
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Maurilio Marcacci
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Alberto Grassi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
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Gong H, Li Q, Len Y, He K, Zhao W, Li Y, Sun G, Peng X, Yin Y. The posterior cruciate ligament index as a reliable indirect sign of anterior cruciate ligament rupture is associated with the course of knee joint injury. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07357-4. [PMID: 36899193 DOI: 10.1007/s00167-023-07357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE The objective of this study was to clarify the clinical value of the posterior cruciate ligament index (PCLI) in anterior cruciate ligament (ACL) rupture, to explore the relationship between the PCLI and course of disease, and to identify the influencing factors of the PCLI. METHODS The PCLI was defined a quotient of the X (the tibial and femoral PCL attachments) and the Y (the maximum perpendicular distance from X to the PCL). A total of 858 patients were enrolled in this case-control study, including 433 patients with ACL ruptures who were assigned to the experimental group and 425 patients with meniscal tears (MTs) who were allocated to the control group. Some patients in the experimental group have collateral ligament rupture (CLR). Information, such as the patient's age, sex, and course of disease, was recorded. All patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The PCLI and the depth of the lateral femoral notch sign (LFNS) were calculated based on the MRI findings, and the characteristics of the PCLI were explored. RESULTS The PCLI in the experimental group (5.1 ± 1.6) was significantly smaller than that in the control group (5.8 ± 1.6) (P < 0.05). The PCLI gradually decreased with time and was only 4.8 ± 1.4 in patients in the chronic phase (P < 0.05). This change was not due to the decrease in X but rather the increase in Y. The results also showed that the PCLI was not related to the depth of the LFNS or injuries of other structures in the knee joint. Furthermore, when the optimal cut-off point of the PCLI was 5.2 (area under the curve = 71%), the specificity and the sensitivity were 84% and 67%, respectively, but the Youden index was just 0.3 (P < 0.05). CONCLUSION The PCLI decreases due to the increase in Y instead of the decrease in X with time, especially in the chronic phase. The change in X in this process may be offset during imaging. In addition, there are fewer influencing factors that lead to changes in the PCLI. Therefore, it can be used as a reliable indirect sign of ACL rupture. However, it is difficult to quantify the diagnostic criteria of the PCLI in clinical practice. Thus, the PCLI as a reliable indirect sign of ACL rupture is associated with the course of knee joint injury, and it can be used to describe the instability of the knee joint. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Heng Gong
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Qingshan Li
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yu Len
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Ke He
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Wenbo Zhao
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yu Li
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Guanjun Sun
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Xu Peng
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yi Yin
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China.
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Farinelli L, Abermann E, Meena A, Ueblacker P, Hahne J, Fink C. Return to Play and Pattern of Injury After ACL Rupture in a Consecutive Series of Elite UEFA Soccer Players. Orthop J Sports Med 2023; 11:23259671231153629. [PMID: 36896098 PMCID: PMC9989402 DOI: 10.1177/23259671231153629] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/09/2022] [Indexed: 03/11/2023] Open
Abstract
Background Anterior cruciate ligament rupture represents a career-threatening injury for professional soccer players. Purpose To analyze the pattern of injury, return to play (RTP), and performance of a consecutive series of elite professional soccer players after anterior cruciate ligament reconstruction (ACLR). Study Design Case series; Level of evidence, 4. Methods We evaluated the medical records of 40 consecutive elite soccer players who underwent ACLR by a single surgeon between September 2018 and May 2022. Patient age, height, weight, body mass index, position, injury history, affected side, RTP time, minutes played per season (MPS), and MPS as a percentage of playable minutes before and after ACLR were retrieved from medical records and from publicly available media-based platforms. Results Included were 27 male patients (mean ± SD age at surgery, 23.2 ± 4.3 years; range, 18-34 years). The injury occurred during matches in 24 players (88.9%), with a noncontact mechanism in 22 (91.7%). Meniscal pathology was found in 21 patients (77.8%). Lateral meniscectomy and meniscal repair were performed in 2 (7.4%) and 14 (51.9%) patients, respectively, and medial meniscectomy and meniscal repair were performed in 3 (11.1%) and 13 (48.1%) patients, respectively. A total of 17 players (63.0%) underwent ACLR with bone-patellar tendon-bone autograft and 10 (37.0%) with soft tissue quadriceps tendon. Lateral extra-articular tenodesis was added in 5 patients (18.5%). The overall RTP rate was 92.6% (25 of 27). Two athletes moved to a lower league after surgery. The mean MPS% during the last preinjury season was 56.69% ± 21.71%; this decreased significantly to 29.18% ± 20.6% (P < .001) in the first postoperative season and then increased to 57.76% ± 22.89% and 55.89% ± 25.8% in the second and third postoperative seasons. Two (7.4%) reruptures and 2 (7.4%) failed meniscal repairs were reported. Conclusion ACLR in elite UEFA soccer players was associated with a 92.6% rate of RTP and 7.4% rate of reinjury within 6 months after primary surgery. Moreover, 7.4% of soccer players moved to a lower league during the first season after surgery. Age, graft selection, concomitant treatments, and lateral extra-articular tenodesis were not significantly associated with prolonged RTP.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | | | - Jochen Hahne
- Football Club FC Bayern München, Munich, Germany
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
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Astur DC, Margato GF, Zobiole A, Pires D, Funchal LFZ, Jimenez AE, Freitas EV, Cohen M. The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07331-0. [PMID: 36779987 DOI: 10.1007/s00167-023-07331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. METHODS A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. RESULTS Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). CONCLUSION A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Diego Costa Astur
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil.
| | - Gabriel Furlan Margato
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Alexandre Zobiole
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Diego Pires
- Real Instituto de Ortopedia, Recife, PE, Brazil
| | | | | | | | - Moises Cohen
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
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