Summary

In professional soccer, RTP at the professional level is high at 97%. Performance metrics show 59% of athletes are at the same league level at 2 years and this decreases to 34% at 5 years post ACLR. Presence of a Grade 3 or 4 chondral lesion significantly decreased performance metrics, while a meniscus repair delayed RTP but did not impact performance metrics at 5 years post ACLR.

Abstract

Introduction

While advances in surgical technique have led to high levels of return to play in professional soccer players, little is known about their medium- and long-term career trajectory and performance.

Methods

A retrospective review was performed of a consecutive series of primary ACL reconstructions in professional soccer players from the senior author’s practice, with a minimum of two-year follow-up. Clinical and performance measures were evaluated at 2- and 5-years post ACLR to determine pre-operative, operative and post-operative factors that affected player performance- measured by the level of league and number of minutes played.

Results

200 male, soccer players were identified who were playing professionally at the time of their primary ACLR. The average age at the time of their primary ACL reconstruction was 24.1±4.2 years. Additional injuries at the time of ACL rupture included 63 (32%) medial meniscus tears with 42 (67%) repaired, 134 (67%) lateral meniscus tears with 82 (62%) repaired, and 31 (16%) chondral lesions of grade 3 or higher. 194 (97%) athletes returned to play (RTP) at 10.7±3.9 months. Return to play was strictly defined as returning to a professional level. Eighteen (9%) athletes sustained a re-rupture at a median of 11.1 months (IQR 8.6-16.6 months) with 6 occurring pre-RTP and 12 post-RTP, while 52 (26%) sustained a contralateral ACL rupture during their soccer career.

At 2 years, performance metrics showed that 59% of athletes were playing in the same or higher-level league, while 15% were in a lower-level league but had more game appearances and minutes played than pre-injury. By 5 years 34% of athletes were playing in the same or higher-level league and 26% were in a lower-level league but had more game appearances and minutes played.

At 2 years, there were no significant predictors of performance when evaluating factors such as concomitant injuries, undergoing surgery after ACLR, or mechanism of injury. However, the presence of a grade 3 or 4 chondral lesion at the time of surgery significantly impacted both career length and performance with only 15% of athletes playing at the same or higher league at 5 years and these athletes were 3.5 times more likely to be playing at a lower league level or retired (p=.029). Meniscus repair lengthened the RTP timeline (11.6 months versus 9.8 months, p=.001), but no impact was seen at 5 years with league level or performance (all p>.05). No other injury characteristic predicted performance at 5 years post ACLR.

Conclusion

While a high level of return to play, 97%, was achieved in professional soccer players following primary ACLR, their performance decreased with time. Performance metrics show 59% of athletes are at the same league level at 2 years and this decreases to 34% at 5 years post ACLR. Presence of a Grade 3 or 4 chondral lesion significantly decreased performance metrics, while a meniscus repair delayed RTP but did not impact performance metrics at 5 years post ACLR.