Severity of Additional Injuries Associated with Primary ACL Injuries in Professional and Amateur Soccer Athletes

Severity of Additional Injuries Associated with Primary ACL Injuries in Professional and Amateur Soccer Athletes

Kyle Borque, MD, UNITED STATES Dylan Ngo, BS, UNITED STATES Mitzi S Laughlin, PhD, UNITED STATES Vítor Hugo Pinheiro, MD, MSc, PORTUGAL Ganesh Balendra, MBBS, AUSTRALIA Mary Jones, MSc, Grad. Dip. Phys., UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM

Houston Methodist, Houston, TX, UNITED STATES


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Anatomic Location

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Diagnosis Method

Cartilage


Summary: Severity of additional injury at ACL rupture is greater in professional players especially for grade 3 or higher chondral injuries.


Objective

Little is known regarding differences in severity of anterior cruciate ligament (ACL) injuries between professional and amateur athletes. The present study was designed to compare incidences of meniscal and chondral injuries in professional soccer players with a cohort of amateur soccer players.

Methods

A retrospective review of a consecutive series of primary ACLR performed at two centers between July 2005 and December 2023 in soccer players, both professional and amateur, was undertaken. Medical records were used to determine the incidence of pathology of the menisci, and medial, lateral, and patellofemoral compartment chondral surfaces. Chronic ACL injury was defined as greater than 1 year between injury to ACLR. Chondral lesions were evaluated according to the International Cartilage Regeneration & Joint Preservation Society (ICRS) grade.

Results

458 soccer players were participating at the professional (n=252) or amateur (n=206) levels at the time of their primary ACLR. Age at ACLR was similar between the two cohorts (professional 24.2±4.3 years vs amateur 25.1±9.5 years, p=.170). There was a significantly greater number of chronic ACL injuries in the amateur (29/206, 14%) than professional athletes (2/252, 1%; p<.001). Excluding chronic cases, professional athletes had a significantly shorter time to ACLR of 21.5 days compared to 74.3 days for amateur athletes (p<.001).

The rate of medial meniscus tears was significantly higher in amateur athletes (84/206, 40%) as compared to professional athletes (72/252, 29%; p=.031), while the rate of lateral meniscus tears did not differ according to playing level (p=.083). Chondral lesions grade ≥ 3 were more prevalent in the professional athletes (15.5%) than the amateur athletes (6.3%, p=.002). The location of chondral lesions also differed by level of play with higher rates in professional athletes for lesions of the medial femoral condyle (p=.010), lateral femoral condyle (p=.005), patella (p=.047) and trochlea (p=.002). There were no significant differences in the rate of medial or lateral tibial plateau lesions between cohorts.

Conclusion

Professional soccer players had a 2.5 times greater incidence of grade 3 or higher chondral injuries at the time of ACL reconstruction while amateur soccer players had a 1.4 times greater chance of a medial meniscus tear. The implication is that the severity of injury at ACL rupture is greater in professional players. Furthermore, given the lower incidence of medial compared to lateral meniscal tears in acute ACL injuries, delayed treatment may account for the higher incidence of medial meniscal tears in amateur soccer athletes.