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. 2023 Jan;31(1):133-141.
doi: 10.1007/s00167-022-07062-8. Epub 2022 Jul 10.

Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the 'ACL registry in German Football'

Dominik Szymski  1   2 , Leonard Achenbach  3   4 , Johannes Weber  5   3 , Lorenz Huber  5   3 , Clemens Memmel  3   6 , Maximilian Kerschbaum  5   3 , Volker Alt  5   3 , Werner Krutsch  5   3   7
Affiliations

Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the 'ACL registry in German Football'

Dominik Szymski et al. Knee Surg Sports Traumatol Arthrosc. 2023 Jan.

Abstract

Purpose: ACL injuries are one of the most severe injuries in football, but medical consequences and performance outcomes after return to competition are only rarely investigated. Aim of this study was to analyse the time of return to competition (RTC) in German professional, semi-professional and amateur football. Also, this investigation highlights the rate of career ending and performance outcome after RTC in different playing levels by the measurement of playing level, performed matches and played minutes.

Methods: Database of this investigation is the 'ACL registry in German Football' with prospectively collected injury data. Between 2014 and 2018, four seasons in professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the return to competition period and performance parameters. Data were collected for three subsequent seasons after injury and compared with the pre-injury and injury season. Data collection was performed using standardized methods.

Results: A total of 607 ACL injuries were registered during the 4-year period with a mean RTC time of 337.1 day (SD: 183). After primary ACL ruptures, the fastest RTC was found in professional football (247.3 days), while in semi-professional (333.5 d; p < 0.0001) and amateur football (376.2 d; p < 0.0001) a prolonged absence was detected. Re-ruptures occurred in 17.8% (n = 108) and showed similar trend with fastest RTC in professionals (289.9 days; p = 0.002). Within the first three seasons after injury, 92 players (36.7%) in semi-professional and 24 (20%) in professionals had to end their career. Keeping the level of play was only possible for 48 (47.5%) of professionals, while only 47 (29.6%) of semi-professionals and 43 (28.1%) of amateurs were able to. Only in professional football, no significant difference could be seen in the played minutes and games after 2 years compared to the pre-injury season.

Conclusion: Lower playing levels and re-ruptures are the main factors for a prolonged return to competition after ACL rupture in German football. Significant reduction in playing level and a high rate of career endings were found for all levels of play. However, only professional players were able to regain their playing minutes and games 2 years after injury, while lower classed athletes did not reach the same amount within 3 years.

Level of evidence: Level III.

Keywords: ACL; Athletic injury; Knee injury; Rehabilitation; Return to play; Sports medicine; Team sport.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Return to competition (RTC) time after ACL injuries (cumulated for primary ruptures and re-ruptures) in different levels of play in Germany
Fig. 2
Fig. 2
Return to competition time in different levels of play in Germany after primary (A) ACL rupture and ACL re-rupture (B)
Fig. 3
Fig. 3
Development of played minutes (A) and number of played matches (B) in the season before ACL injury, the season of injury and three subsequent seasons in German football
Fig. 4
Fig. 4
Development career endings and levels of play compared to the pre-injury season within a time period of three seasons after ACL injury in professional (A), semi-professional (B) and amateur (C) football
See this image and copyright information in PMC

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References

    1. Brophy RH, Schmitz L, Wright RW, et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med. 2012;40:2517–2522. doi: 10.1177/0363546512459476. - DOI - PMC - PubMed
    1. Carli A, Koverech G, Gaj E, et al. Anterior cruciate ligament injury in elite football players: video analysis of 128 cases. J Sports Med Phys Fitness. 2022;62:222–228. doi: 10.23736/S0022-4707.21.11230-7. - DOI - PubMed
    1. Della Villa F, Buckthorpe M, Grassi A, et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. 2020;54:1423–1432. doi: 10.1136/bjsports-2019-101247. - DOI - PubMed
    1. Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc. 2020;28:2390–2402. doi: 10.1007/s00167-020-06012-6. - DOI - PMC - PubMed
    1. von Essen C, McCallum S, Barenius B, Eriksson K. Acute reconstruction results in less sick-leave days and as such fewer indirect costs to the individual and society compared to delayed reconstruction for ACL injuries. Knee Surg Sports Traumatol Arthrosc. 2020;28:2044–2052. doi: 10.1007/s00167-019-05397-3. - DOI - PMC - PubMed