EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT INJURY IN SOCCER PLAYERS IN THE BRAZILIAN CHAMPIONSHIP

Sport-related concussion in Brazilian professional soccer: A four-year prospective epidemiological analysis

This study aimed to investigate the incidence and other significant features of craniomaxillofacial trauma (CMFT), particularly Sport-Related Concussion (SRC), among professional soccer players from two major leagues in Brazil. This is a prospective epidemiological study which assessed two divisions of the national championship and large regional one over four seasons. Data were gathered from soccer clubs and their medical staff using two online forms. Data related to players (age and position) and injuries (diagnosis, type, body location, laterality, field location, tests performed, need for surgery, time lost in sports, and recurrence) were collected. Between 2016 and 2019, a total of 15 seasons, comprising 3 828 matches and 126 ​324 hours (h) of gameplay, were analyzed. A total of 299 CMFT cases were reported, with a median incidence of 2.37 per 1 000 ​h of play. Among them, there were 178 head and 121 face traumas, which led to 87 SRC (representing 29.10% of all CMFT), with an incidence of 0.69. Defensive midfielders (14.43%) and goalkeepers (14.00%) had the highest prevalence rates of CMFT. Only 3.68% of the injuries, mostly lacerations and fractures, required surgical treatment. This study identified that the average time lost in sports due to SRC was 5.12 days, with a recurrence rate of 12.71%. SRC are a frequent consequence of CMFT in Brazilian professional soccer. Although most cases are mild, there is a high recurrence rate, which may have long-term implications.

Cortical changes associated with an anterior cruciate ligament injury may retrograde skilled kicking in football: preliminary EEG findings

Anterior cruciate ligament injuries (ACLi) impact football players substantially leading to performance declines and premature career endings. Emerging evidence suggests that ACLi should be viewed not merely as peripheral injuries but as complex conditions with neurophysiological aspects. The objective of the present study was to compare kicking performance and associated cortical activity between injured and healthy players. Ten reconstructed and 15 healthy players performed a kicking task. Kicking biomechanics were recorded using wearable inertial measurement unit sensors. Cortical activity was captured with a 64-electrode mobile electroencephalography. Multiscale entropy (MSE) analysis of biomechanics revealed increased variability in foot external rotation among injured players. Source-derived event-related spectral perturbations indicated significant differences in posterior alpha and frontal theta oscillations between the two groups. Furthermore, kick-related complexity of these regions as indexed by MSE was reduced in injured players at medium and coarse scales. Our findings suggest sensorimotor changes during kicking in injured players, which may necessitate compensatory strategies involving augmented attention at the cost of processing visuospatial information. This conflict may hinder the integration of task-relevant information across distributed networks. Our study provides preliminary insights into the neurophysiological implications of ACLi within football context and underscores the potential for prospective research.

12.5% of all women's and 7.7% of all men's players from the 2022 and 2023 FIFA World Cups underwent a previous anterior cruciate ligament reconstruction

Purpose

To evaluate the incidence of anterior cruciate ligament (ACL) reconstructions in athletes who participated in the men's 2022 and women's 2023 Federation Internationale de Football Association (FIFA®) World Cups, comparing the incidence between genders, positions and the stages reached by the teams during the competition.

Methods

This is a media analysis study, and data were collected from official club and FIFA® websites: a list of athletes who played during the men's 2022 and women's 2023 FIFA® World Cup, a list of athletes who already did an ACL reconstruction (ACLR) and rehabilitation before the competition, and stages from each team during the competition.

Results

12.5% of the athletes in the women's competition (92 athletes) and 7.7% in the men's competition (64 athletes) underwent ACLR surgery before. When comparing positions (goalkeeper, defence, midfield and forwards), there were no statistical differences between men (p = 0.97) and women (p = 0.26). According to the competition stage, the prevalence increased from 12.5% in the group stage to 17.4% in the finals (p = 0.05) for women and ranged from 6.8% to 7.9% (p = 0.87) among men. The number of ACL revision surgeries was 18 in women players (2.4% of total, 19.4% of those operated) and 5 in men players (0.6% of total, 7.5% of those operated). No statistical difference in revision rates between men and women (p = 0.16).

Conclusion

In the highest football level competition in the world (FIFA® World Cup), there was no statistical difference between the number of men and women called up and who participated after ACLR, rehabilitation and return to sport (12.5% vs. 7.7%; p > 0.05). Furthermore, the incidence of ACL-operated players belonging to each team that played in the World Cup increased from the stage of groups to the final in the female category (p = 0.05), but remained stable in the male category (p = 0.87).

Level of Evidence

Not applicable.

Ankle Sprains in Brazilian Professional Soccer: Epidemiological Analysis of 126,357 Match Hours

Objective  This study aimed to perform an epidemiological analysis of ankle sprains in professional soccer players in Brazil. Methods  This prospective epidemiological study analyzed ankle sprains in professional male soccer athletes during the Brazilian Championship and the Paulista Football Championship from 2016 to 2019. All on-pitch medical care provided in official matches was recorded. The variables evaluated included the age and position of the player, injury diagnosis, pitch site where the injury occurred, playing time, imaging tests performed, surgical treatment, time away from competitions, and injury recurrence. We assessed the incidence of injuries according to the Federation Internationale de Football Association (FIFA) incidence formula. Results  Ankle sprains represented 10.17% of total injuries, with a FIFA index equal to 2,002. Lateral ligament injuries represented 53.75% of all sprains. The forwards were the most injured athletes, with 86 lesions. The midfield had the highest number of sprains (75.50%). Almost half (47.04%) of sprains occurred in the final 15 minutes of each half-time. Injuries recurred in 31.22% of cases, and 7.11% of injuries underwent surgical treatment. The average time away from competitions was 13.95 days. Conclusions  Ankle sprains are common injuries in soccer. Although the average time to return to sport is brief, these injuries have a high recurrence rate and are potentially surgical, leading to a longer time off competitions.

Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology and Details of Return to Sports

Background

There are limited data on the epidemiology of anterior cruciate ligament (ACL) ruptures in elite adult soccer players, especially in the Russian Premier League (RPL). There is an increased risk of injury due to a combination of additional risk factors such as playing in extremely high and low temperatures, frequent long flights, and regular play on natural and artificial surfaces.

Purpose

To study the epidemiology of ACL ruptures and determine the patterns associated with their occurrence in RPL soccer players.

Study Design

Descriptive epidemiology study.

Methods

All ACL ruptures requiring surgery sustained by players competing in the RPL across 12 competitive seasons between 2010 and 2022 were analyzed. All required data were collected from media analysis and confirmed by club doctors.

Results

A total of 85 players sustained 100 injuries during 12 competitive seasons. A total of 96.5% of players returned to competitive play. The injury incidence in RPL and during participation of RPL teams in European Cups were 0.4760 and 0.5622 per 1000 playing hours, respectively. When analyzing the outcomes of the primary ACL surgery (a total of 76 operations), the following data were obtained: in 11 cases (14.5%), there was a reinjury on the ipsilateral knee joint and in 4 cases (5.3%) on the contralateral knee joint. The mean return-to-play time after all operations was 284 ± 116 days. The time of return to play after primary reconstruction was 289 ± 136 days, 278 ± 91 days after reconstruction on the contralateral knee and 271 ± 51.5 days after the first ACL revision reconstruction on the ipsilateral knee joints.

Conclusion

RPL ACL injury epidemiology is similar to that in the other leagues from around the world, although there are factors that can potentially influence the number of these injuries.

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games

OBJECTIVES

Football is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships.

METHODS

Data were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula.

RESULTS

A total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days.

CONCLUSION

Shoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport.

LEVEL OF EVIDENCE

III.

Return to training in soccer players after anterior cruciate ligament reconstruction: reflections and considerations

This clinical and rehabilitative overview focuses on the return to unrestricted sporting activity, aiming to consolidate the scientific evidence surrounding the structural progression of athletes, particularly footballers, undergoing anterior cruciate ligament reconstruction (ACLR). A multidisciplinary approach necessitates a shared language and standardized methodologies. Unfortunately, significant disparities persist in the structural strategies guiding the decision-making process for returning to on-field activities, the latter stages of rehabilitation, and subsequent restoration of technical and tactical football abilities. Divergences in definitions, terminologies, and rehabilitation protocols can substantially influence final outcomes. Presently, scientific consensus studies regarding the decision-making process during the final stages of on-field rehabilitation are lacking. Nevertheless, this overview outlines and defines pivotal language parameters crucial for effective communication and the seamless integration of clinical and rehabilitative data among the diverse professionals involved in facilitating the athlete's return to peak performance. In conclusion, the successful resumption of competitive sporting activities for footballer's post ACLR demands a collaborative decision-making approach encompassing various professionals. Additionally, it necessitates a cohesive transition from rehabilitation to on-field work, aiming at reinstating athleticism, technical prowess, and tactical acumen.

The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis

PURPOSE

To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years.

METHODS

A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division.

RESULTS

Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001).

CONCLUSION

A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions.

LEVEL OF EVIDENCE

IV.

Epidemiology of Upper Limb Injuries in two major Brazilian Soccer Championships from 2016 to 2019

PURPOSE

To evaluate epidemiological data of upper limb injuries in professional athletes who participated in two major Brazilian soccer championships between 2016 and 2019.

METHODS

A prospective cohort study was conducted to evaluate the teams of two divisions over four seasons within the Brazilian Soccer Championship and the Paulista Soccer Championship. Clubs and their doctors were contacted to participate in the study and guided on the correct way to enter data via online platforms: Transfermarkt (Transfermarkt GmbH & Co. KG) and Survey Monkey (Momentive.AI). Demographic data, injury characteristics, and FIFA Incidence Formula were analyzed.

RESULTS

Overall, the study analyzed 3,828 matches and 126,357 hours of play. Upper limb injuries were registered 169 times, representing 6.8% of total injuries, with a FIFA incidence of 1.34. Most lesions occurred in forward players (21.3%), the shoulder exhibited the highest number of injuries (63.3%). The player's position was related to the location on the field where the injury occurred (p < 0.001); however, there was no relationship between the type of injury and the location on the body (p > 0.001). The average time to return to play was 19.1 days (range 0-200 days) and it was longer for goalkeepers. The necessity of surgical treatment was statistically associated with additional time to return to play (p < 0.001).

CONCLUSIONS

Shoulder injuries were the most frequent upper limb injury sustained during the two major Brazilian soccer championships. Forward players suffered the most upper limb injuries and goalkeepers experienced the longest time to return to play.

Influence of type I collagen polymorphisms and risk of anterior cruciate ligament rupture in athletes: a case-control study

BACKGROUND

Anterior cruciate ligament (ACL) rupture is a common and severe knee injury in sports and occurs mostly due to noncontact injuries. There is an increasing amount of evidence associating ACL rupture to single nucleotide polymorphisms (SNPs), and SNPs in the collagen type I genes can change its expression and tissue mechanical features. This study aimed to investigate the association between SNPs in COL1A1 and COL1A2 with sports-related ACL tears.

METHODS

A total of 338 athletes from multiple sports modalities were analyzed: 146 were diagnosed with ACL rupture or underwent an ACL reconstruction surgery and 192 have no musculoskeletal injuries. SNPs were genotyped using validated TaqMan assays. The association of the polymorphisms with ACL rupture was evaluated by a multivariable logistic regression model, using odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

The age, sport modality, and training location were associated with an increased risk of a non-contact ACL tear. COL1A2 SNPs (rs42524 CC and rs2621215 GG) were associated with an increased risk of non-contact ACL injury (6 and 4-fold, respectively). However, no significant differences were detected in the distribution of COL1A1 rs1107946 and COL1A2 rs412777 SNPs between cases and controls. There was a protective association with ACL rupture (OR = 0.25; 95% CI = 0.07-0.96) between COL1A1 rs1107946 (GT or TT) and the wildtype genotypes of the three COL1A2 (rs412777, rs42524, rs2621215). COL1A2 rs42524 and rs2621215 SNPs were associated with non-contact ACL risk.

CONCLUSION

The combined analysis of COL1A1-COL1A2 genotypes suggests a gene-gene interaction in ACL rupture susceptibility.

Patellar tendon versus artificial grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Background

The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL.

Objective

To compare autografts and synthetic grafts in terms of postoperative knee stability and function

Search methods

The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool.

Selection criteria

We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications).

Results

A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts.

Conclusions

This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals.

Level of evidence

Level I, systematic review and meta-analysis