Sustained participation deficits following anterior cruciate ligament reconstruction in elite male soccer players globally.

Abstract

Anterior cruciate ligament (ACL) injuries have been associated with reduced career longevity and decreased match participation in professional soccer players. Minutes played per match (MPM) offers an objective, normalised metric that captures not only return-to-play success but also the degree of sustained participation in competitive matches. This study sought to evaluate changes in match participation before and after ACL reconstruction in elite soccer players using MPM and related participation metrics. Player and match data were sourced from Transfermarkt.com. Professional soccer players from first or second-tier leagues globally who sustained ACL injuries between January 2007 and December 2022 with reported absence greater than 90 days were identified. The date of injury was considered 'time zero'. Year -1 corresponds to the 360 days preceding injury, and Year 1 to the interval between 361 and 720 days after injury. The primary outcome was MPM, calculated as total minutes played divided by number of appearances. The primary analysis compared MPM between Year -1 and Year 1 in players who returned to play with at least five appearances in Year -1 and 3 appearances in Year 1. Statistical significance was set at p < 0.05. After applying exclusion criteria, 9071 ACL injuries in 8022 unique players were included. Of these, 7172 injuries (79.1%) resulted in successful return to professional play, with mean time to return of 255.7 days. For the primary analysis, 4596 players with adequate match participation data were included. Mean MPM decreased significantly from 67.4 ± 19.3 min in Year -1 to 56.5 ± 23.3 min in Year 1 (p < 0.001), representing a mean reduction of 10.8 min (16.1% relative decrease) with moderate effect size (Cohen's d = 0.51). Median MPM decreased from 72.1 min to 59.8 min. Mean appearances per year decreased from 21.5 to 14.7, and total minutes played per year decreased from 1527 to 924. While 79.1% of elite soccer players return to professional play following ACL reconstruction, there is a significant and clinically meaningful reduction in match participation as measured by MPM. Athletes and clinicians should be counselled regarding realistic expectations for post-ACLR participation levels. Level III.