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. 2020 May/Jun;12(3):279-288.
doi: 10.1177/1941738119885642. Epub 2019 Dec 4.

Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players

Alberto Grassi  1 , Luca Macchiarola  1 , Matteo Filippini  1 , Gian Andrea Lucidi  1 , Francesco Della Villa  2 , Stefano Zaffagnini  1
Affiliations

Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players

Alberto Grassi et al. Sports Health. 2020 May/Jun.

Abstract

Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury.

Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league.

Study design: Descriptive epidemiological study.

Level of evidence: Level 4.

Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated.

Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003).

Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league.

Clinical relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors.

Keywords: ACL; Serie A; anterior cruciate ligament; epidemiology; football (soccer); professional.

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Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
Percentage of primary anterior cruciate ligament (ACL) injuries (black bar), ipsilateral rerupture (dark-gray bar), and contralateral ACL injuries (light gray bar) according to player position.
Figure 2.
Figure 2.
Incidence rates for anterior cruciate ligament (ACL) injury per 1000 hours of Serie A matches (green), 1000 hours of training (blue), and 1000 hours of total play (red).
Figure 3.
Figure 3.
Distribution along the year of total anterior cruciate ligament (ACL) injuries (red), injuries occurred during Serie A matches (green), and injuries occuring during training (blue).
Figure 4.
Figure 4.
Comparison of incidence rates (top) and incidence proportions (bottom) of anterior cruciate ligament (ACL) injuries between teams ranked in 1st through 4th position (blue) and teams ranked in 5th through 20th position (orange). Asterisk (*) indicates statistically significant difference.
See this image and copyright information in PMC

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