Return-to-play timing and secondary anterior cruciate ligament injury risk in elite soccer players: A transfermarkt-based longitudinal analysis.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 42164842.
- Also identified by DOI 10.1002/jeo2.70763 and PMC identifier 13185221.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Anterior cruciate ligament (ACL) injuries are frequent and potentially career-threatening in elite soccer. The optimal timing for return-to-play (RTP) remains debated, particularly its association with secondary ACL injury. This study evaluated temporal trends in RTP duration and investigated the association between RTP duration, post-ACL match exposure and secondary ACL injury risk in professional male soccer players. Longitudinal publicly available data were analysed from Transfermarkt (2005-2020) on ACL injuries in elite male soccer players from Germany, France, Italy, Spain and the United Kingdom. Players were grouped into three five-season periods. Multivariable logistic regression was used to examine the association between RTP duration (days) and secondary ACL injury risk, adjusting for time period, post-ACL match exposure (per 1000 min) and age. Secondary ACL injury proportions and RTP duration trends were compared across time periods. A total of 1011 ACL injuries were identified in 862 unique players; 15.5% (<i>n</i> = 134) sustained ≥2 ACL injuries. Mean RTP duration increased over time (196.7 ± 50.9 days in 2005-2010 vs. 219.9 ± 67.4 days in 2015-2020; <i>p</i> < 0.001). The proportion sustaining a secondary ACL injury increased from 9.0% to 16.4% (<i>p</i> = 0.031). Post-ACL match exposure was strongly associated with reinjury risk (OR: 1.39 per 1000 min, <i>p</i> < 0.001), and younger age was independently associated with higher risk (OR: 0.86 per year, <i>p</i> < 0.001). After adjustment, players in 2010-2020 still exhibited <i>a</i> > 2-fold higher reinjury risk compared with 2005-2010 (<i>p</i> < 0.05). Longer RTP duration was not protective and showed a small positive association with reinjury risk (OR: 1.004, <i>p</i> = 0.034). Although RTP duration has increased over the past 15 years in elite soccer, this has not reduced secondary ACL injury risk. Extending RTP duration alone does not appear to reduce reinjury risk. Level III, retrospective cohort study.