The anterior cruciate ligament rupture (ACL) is a complicated injury for football players. Apart from leaving players out of the competition for a long period, it can cause early osteoarthritis.¹ Although the frequency of ligament injury in general, including sprained ankle and knee lateral ligaments, has notably reduced in the last decade, ^2-5 we know much less about the incidence and development of the ACL rupture.

A research⁶ has analyzed how the return to training and competition of players who have suffered an ACL rupture. The study, published in the British Journal of Sports Medicine magazine in 2016, focused on the analysis of 78 elite teams from 16 different European countries during fifteen consecutive seasons from January 2001 to May 2015 (365 seasons analyzed and 10,157 players/seasons). A member of the technical staff of each club recorded the exposure time in minutes of each player during the training seasons and matches played with the club and the national team. The ACL injury was defined as the total rupture for the first time of the ligament or the recurring partial or total rupture in isolation or associated with other injuries of the knee joint. The players’ recovery (Return to Play, RTP) was defined as the number of days from when the injury or the reconstruction of the ligament took place, until the first day of complete training without restrictions (back to training) and the first match (back to competition).

Results suggest some very relevant conclusions:

• ACL injury hasn’t reduced in the last 15 years in elite football.
• The frequency of the ACL injury was of 0.4 per team and season, which means that a member of the team will suffer an ACL injury every two seasons.
• Training sessions cause a very low injury risk in ACL. The frequency of the injury is 20 times greater in competitive matches.
• 98,6% of players with a total rupture were subjected to an ACL reconstruction.
• All players were capable of coming back to training, but 7% (9 of them) suffered complications before playing the first match (a new rupture or other complications in the knee).
• The average downtime after ACL reconstruction was of 6.6 months to come back to training and of 7.4 months to come back to competition.
• Coming back to competition a year after suffering an ACL injury was high (85.8%); however, only 65% (60 out of 93 players) were capable of competing at the highest level three years later.

Although there are interesting insights from these conclusions, this research still leaves some unanswered questions. To begin with, it is not the same to come back to compete than recovering the same level of performance prior to the injury. More research has to be done to analyze if players who have suffered the ACL rupture get to recover completely their best state to compete or not, and the time necessary to do so. Secondly, other variables like the specific position or the players’ age can influence recovery times.

Carlos Lago Peñas

References:

¹ Von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient-relevant outcomes. Ann Rheum Dis 2004; 63:269–73.

² Erickson BJ, Harris JD, Cvetanovich GL, et al. Performance and return to sport after anterior cruciate ligament reconstruction in male Major League Soccer players. Ort J Sports Med 2013; 1: 2325967113497189.

³ Ekstrand J, Hägglund M, Kristenson K, et al. Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47:732–7.

⁴ Lundblad M, Waldén M, Magnusson H, et al. The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play. Br J Sports Med 2013; 47:759-62.

⁵ Waldén M, Hägglund M, Ekstrand J. Time-trends and circumstances surrounding ankle injuries in men’s professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47:748–53.

⁶ Waldén M, Hägglund M, Magnusson H, et al. ACL injuries in men’s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med 2016; 50:744–750