Summary

Epidemiological evaluation of the impact of ACL injury and Achilles tendon rupture on professional soccer players’ careers.

Abstract

Introduction

In terms of performance, complications, and players ' market value, the impact of anterior cruciate ligament (ACL) injury and Achilles’ tendon (AT) rupture on professional soccer players’ careers have not been extensively investigated. This descriptive epidemiology study aimed to compare the return-to-play (RTP) rate, career survival, athletes' performance, and market values in the first 3 postoperative seasons after surgery for ACL or AT injury in soccer players.

Methods

In this retrospective study, the authors identified male professional soccer players who sustained, in the current top-eight European Soccer Leagues according to the United European Football Association (UEFA) Country Ranking, and an ACL tear from 2014 to 2017 and ATR in the period between 2010 and 2020. From the included player, age, BMI, position, injury history, affected side, RTP rate and time, and percentage of played minutes per season (MPS) before and after ATR were retrieved from the publicly available media-based platform Transfermarkt (www.Transfermarkt.com). RTP time was assessed as the number of days from an ACL/ATR to the first match appearance with the first team. MPS was defined as the percentage of the played minutes on the total playable minutes during each season. The mean MPS was calculated for the three pre-injury and post-injury seasons. Complications were defined as re-ruptures, re-operation or any adverse event occurring within the rehabilitation period resulting in a delayed or missed RTP.

Results

Overall, 179 players sustained an ACL injury and 71 an AT rupture. The mean age was 25.6 for ACL and 28.5 for AT (p=0.000); the BMI was lower in ACL (22.81) than in AT (23.20) (p=0.046). No difference was found in field position or affected side. The dominant side was the left in 28.7% for ACL and 11.3% for AT (p=0.044). The RTP rate after the injury was 98.3% for ACL and 100.0% for AT (p=0.271), with a mean RTP time of 238.3 days for ACL and 216,2 for AT (p=0.156). No difference was found considering the MPS after the injury. Within the third season, 73.8% of players in the ACL group and 69.8% in AT group competed in a top-level league (p=0.754), and respectively 13.5% and 15.5% ended their careers (p=0.680). Re-ruptures occurred in 4.5% of the ACL group and 2.8% of AT group. The market value increased similarly in both groups (p=0.271).

Discussion And Conclusion

The difference in the pathogenesis and the incidence in professional football between ACL and AT injuries did not correspond to a difference in outcomes. The ACL injury occurs in younger players than the AT one, and this difference must be taken into account during the analysis and the interpretation of results. Considering the MPS, the two groups achieved similar results. The RTP found in this study is comparable to the RTP available in the literature and similar between the two groups. In conclusion, with available surgical and rehabilitation techniques, an AT or ACL injury can be considered as having a major impact event in football player's, but with an overall limited impact on their career.