Sports Medicine Research: In the Lab & In the Field: Return to Sport Does Not Mean Return to Same Performance Level (Sports Med Res)

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Monday, August 6, 2018

Return to Sport Does Not Mean Return to Same Performance Level

Return to play, performance, and career duration after anterior cruciate ligament rupture: A case-control study in the five biggest football nations in Europe.

Niederer D, Engeroff T, Wilke J, Vogt L, Banzer W. Scand J Med Sci Sports. 2018. [Epub Ahead of Print].
Take Home Message: Elite soccer players have rates of high return to play after an ACL reconstruction; however, it can take up to 2 years to return to a similar performance level as their peers. Furthermore, they may be more likely to have a shorter career than their peers.
https://upload.wikimedia.org/wikipedia/commons/2/24/Germany_and_Argentina_face_off_in_the_final_of_the_World_Cup_2014_-2014-07-13_%286%29.jpg
While many patients after an anterior cruciate ligament (ACL) reconstruction return to play, they are at risk for serious long-term problems (e.g., re-injury, osteoarthritis), which could adversely affect his/her performance level after returning to play. Prior investigators have struggled to account for various factors that may contribute to retirement or diminished performance after an ACL reconstruction. Therefore, the authors looked at top-level European football (soccer) athletes to compare return-to-play rates, career duration, and game performance of athletes who underwent ACL reconstruction and matched control athletes. The athletes were injured during the 2010/2011 and 2011/2012 seasons and followed for 5 years’ post-injury. The authors extracted patient demographics, injury history, and return-to-play data from Transfermarkt.de. They also extracted player performance data from Whoscored.com. For each injured player, the authors selected 2 matched players with no history of knee injury based on age, playing position, country of play, league of play, and market value. Overall, the authors identified 132 ACL ruptures in 125 players (~25 years of age; 10% reinjury rate in 5 years) that resulted in a wide range of games lost (1-90 games), and approximately 209 days between rupture and first match appearance. Goal keepers and center backs returned quicker than forwards. Overall, both groups had over a 90% of athletes return to play the next season. However, players that suffered an ACL rupture had shorter careers than healthy players. The authors also found that players with an ACL rupture had decreased performance (minutes per season, scoring points) for up to 2 years after the injury.

This study was interesting because the authors found that though nearly all athletes returned to sport in this population, players that underwent an ACL reconstruction had poorer performance indicators and shorter careers than healthy peers. It would be interesting to follow up and ascertain why players had earlier retirements (life planning, pain, fear of reinjury). It was also interesting to note that position may influence return-to-play time. More information about differences in technical skills, neuromuscular performance, pressure to return between positions could be helpful to individualize rehabilitation and return-to-play programs. Lastly it is thought-provoking that impaired game performance only lingered for up to 2 years after reconstruction, this could suggest that the real return to performance for these elite players may take as long as 2 years. Medical professionals need to consider this information to create programs for long-term joint health. Furthermore, they may need to consider continuing ACL rehabilitation beyond return to play and be pro-active to help prevent ACL rerupture.

Questions for Discussion: Do you continue to work with athletes that had ACL reconstruction after they returned to play? If so, what does your program consist of? Did you notice a decline in reruptures?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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