ACL Injuries in Soccer Players: Prevention and Return to Play Considerations

Abstract

Soccer is the most popular sport in the world, with an estimated 270 million people, or 4% of the world's population, currently playing.1 Soccer has recently enjoyed an elevated profile with the US women's national team competing in the 2023 World Cup. Meanwhile, there is regional excitement with Kansas City selected as a host city of the upcoming 2026 men's World Cup (logo left). Knee injuries, particularly ACL tears, are common in soccer and can lead to extensive time away from sport. Increasing emphasis is being placed on reducing soccer related injuries as well as improving outcomes when returning players back to competitive play.

Figure 1

Hop tests - maximal hop (tests force production), maximal controlled leap (tests force absorption), and triple crossover hop (test limb symmetry)

Figure 2

FMS Inline Lunge - Place the body in a position to focus on the stresses as simulated during rotation, deceleration, and lateral movements

Figure 3

Pro agility - Requires athletes to accelerate 5 yards, change direction, accelerate 10 yards, change direction again and accelerate 5 yards to the finish line

Figure 4

Y-balance – Used to measure dynamic balance. The 3 directions anterior, posteromedial, and posterolateral

Figure 5

Weighted squat – Consistently maintain the following criteria: neutral lumbar spine, elbows come down inside knees, no valgus/varus sway at knees, no lateral weight shift, feet stay flat, no trunk rotation, femurs at least parallel to floor, and knees track over feet

Figure 6

Single Leg Romanian Dead Lift - Consistently maintain the following criteria: neutral spine, no valgus collapse, no knee hyperextension, no midline crossover of back leg, and no hip rotation