Higher risk of ACL rupture in amateur football compared to professional football: 5-year results of the ‘Anterior cruciate ligament-registry in German football’

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Abstract

Purpose

Anterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature.

Methods

This study is based on the prospective ‘ACL registry in German Football’ implemented in the 2014–15 season. Professional (1st–3rd league), semi-professional (4th–6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014–15 to the 2018–19 football season.

Results

Overall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%).

Conclusion

This sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention.

Level of evidence

II.

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Most cited references 35

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Injury incidence and injury patterns in professional football: the UEFA injury study.

J Ekstrand, Patricia M. Walden, M Hägglund (2011)

To study the injury characteristics in professional football and to follow the variation of injury incidence during a match, during a season and over consecutive seasons. Prospective cohort study where teams were followed for seven consecutive seasons. Team medical staff recorded individual player exposure and time-loss injuries from 2001 to 2008. European professional men's football. The first team squads of 23 teams selected by the Union of European Football Associations as belonging to the 50 best European teams. Injury incidence. 4483 injuries occurred during 566 000 h of exposure, giving an injury incidence of 8.0 injuries/1000 h. The injury incidence during matches was higher than in training (27.5 vs 4.1, p<0.0001). A player sustained on average 2.0 injuries per season, and a team with typically 25 players can thus expect about 50 injuries each season. The single most common injury subtype was thigh strain, representing 17% of all injuries. Re-injuries constituted 12% of all injuries, and they caused longer absences than non re-injuries (24 vs 18 days, p<0.0001). The incidence of match injuries showed an increasing injury tendency over time in both the first and second halves (p<0.0001). Traumatic injuries and hamstring strains were more frequent during the competitive season, while overuse injuries were common during the preseason. Training and match injury incidences were stable over the period with no significant differences between seasons. The training and match injury incidences were stable over seven seasons. The risk of injury increased with time in each half of matches.

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Methods for epidemiological study of injuries to professional football players: developing the UEFA model.

J Ekstrand, M Hägglund, R Bahr … (2005)

A problem with epidemiological studies of football injuries is the inconsistent manner in which injury is defined and data are collected. Projects have been initiated to study the incidence and causes of injury in football, but there is no uniformly accepted reporting system. In this report, some common pitfalls encountered in the recording of injury are addressed, and practical guidelines for epidemiological studies are provided. An injury reporting system developed for the UEFA Football Safety Project for studies on professional footballers is used as a starting point for a general discussion on injury registration and compared with other existing reporting systems. The recording definition of injury may vary between studies depending on its purpose. A time loss injury definition is practical for all playing levels, and, as a minimum, results on time loss injuries should therefore always be reported separately to allow direct comparisons between studies. There is a need to agree on a uniform sports injury classification system with corresponding diagnostic criteria, as well as standardised return to play criteria after injury.

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ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture.

Markus Waldén, Martin Hägglund, Henrik Magnusson … (2016)

Studies investigating the development of ACL injuries over time in football are scarce and more data on what happens before and after return to play (RTP) are needed.

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Author and article information

Contributors

Dominik Szymski:

ORCID: http://orcid.org/0000-0002-1739-8524

dominik.szymski@me.com

Journal

Journal ID (nlm-ta): Knee Surg Sports Traumatol Arthrosc

Journal ID (iso-abbrev): Knee Surg Sports Traumatol Arthrosc

Title: Knee Surgery, Sports Traumatology, Arthroscopy

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0942-2056

ISSN (Electronic): 1433-7347

Publication date (Electronic): 15 September 2021

Publication date PMC-release: 15 September 2021

Publication date (Print): 2022

Volume: 30

Issue: 5

Pages: 1776-1785

Affiliations

[1 ]GRID grid.411941.8, ISNI 0000 0000 9194 7179, Department of Trauma Surgery, , University Medical Centre Regensburg, ; Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany

[2 ]GRID grid.8379.5, ISNI 0000 0001 1958 8658, Department of Orthopedics, , König-Ludwig-Haus, Julius-Maximilians-University Würzburg, ; Würzburg, Germany

[3 ]Department of Trauma Surgery, Caritas Hospital St. Josef, Regensburg, Germany

[4 ]GRID grid.411941.8, ISNI 0000 0000 9194 7179, Centre for Clinical Studies, , University Hospital Regensburg, ; Regensburg, Germany

[5 ]SportDocsFranken, Nürnberg, Germany

Author information

Dominik Szymski http://orcid.org/0000-0002-1739-8524

Article

Publisher ID: 6737

DOI: 10.1007/s00167-021-06737-y

PMC ID: 9033691

PubMed ID: 34524500

SO-VID: 91d41573-aefa-4669-861a-1a8828797fbe

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 May 2021

Date accepted : 2 September 2021

Funding

Funded by: Verwaltungs-Berufsgenossenschaften (VBG)

Funded by: Universitätsklinikum Regensburg (8921)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

issue-copyright-statement © The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022

ScienceOpen disciplines: Surgery

Keywords: anterior cruciate ligament,knee injury,injury prevention,football

Data availability:

ScienceOpen disciplines: Surgery

Keywords: anterior cruciate ligament, knee injury, injury prevention, football

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Higher risk of ACL rupture in amateur football compared to professional football: 5-year results of the ‘Anterior cruciate ligament-registry in German football’

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25th European Students' Conference

Most cited references 35

Injury incidence and injury patterns in professional football: the UEFA injury study.

Methods for epidemiological study of injuries to professional football players: developing the UEFA model.

ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture.

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