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. 2021 Sep 8;9(9):23259671211024218.
doi: 10.1177/23259671211024218. eCollection 2021 Sep.

Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes

Ophelie Lavoie-Gagne  1 , Matthew F Gong  2 , Sumit Patel  1 , Matthew R Cohn  1 , Avinaash Korrapati  1 , Enrico M Forlenza  1 , Moses Barmonyallah  2 , Kevin C Parvaresh  1 , Theodore S Wolfson  1 , Brian Forsythe  1
Affiliations

Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes

Ophelie Lavoie-Gagne et al. Orthop J Sports Med. .

Abstract

Background: The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance.

Purpose: To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance.

Study design: Cohort study; Level of evidence, 3.

Methods: Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position.

Results: A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes (P < .05), scored 0.09 more assists per game (P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury (P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games (P < .05), 603 fewer total minutes (P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury (P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls.

Conclusion: Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.

Keywords: case-control; football (soccer); general sports trauma; lower extremity fracture; performance outcomes.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.R.C. has received hospitality payments from Medical Device Business Services. K.C.P. has received grant support from Arthrex and Acumed and educational support from Smith & Nephew. B.F. has received research support from Arthrex, Stryker, and Smith & Nephew; consulting fees from Stryker; education payments from Medwest; and personal fees from Elsevier; and has stock/stock options in Jace Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Player retention in the leagues by injury status during the study follow-up period. LE, lower extremity.
Figure 2.
Figure 2.
Player performance and field time: (A) games played, total time played in minutes, and minutes per game, and (B) points per game, goals per 90 minutes, and assists per 90 minutes. Statistically significant differences between study groups: *P < .05, **P < .01, ***P < .001. LE, lower extremity.
Figure 3.
Figure 3.
Field time metrics by player position. Statistically significant differences between study groups: *P < .05, **P < .01. LE, lower extremity.
Figure 4.
Figure 4.
Performance metrics by player position. Statistically significant differences between study groups: *P < .05, **P < .01, ***P < .001. LE, lower extremity.
See this image and copyright information in PMC

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