Knee Injuries in Elite Level Soccer Players
TAKE-HOME POINTS
- Soccer is one of the most popular sports in the world and has a high incidence of resultant knee injuries.
- Significant, identifiable risk factors put soccer players at risk for serious knee injuries, such as ACL ruptures; age, female sex, and position played influence injury susceptibility.
- ACL injury most commonly occurs via non-contact mechanisms, and female players are at a significantly higher risk of ACL injury than male counterparts.
- The prevalence of osteoarthritis in retired soccer players is high, underscoring the need to be familiar with meniscal and cartilage repair/restoration techniques and associated outcomes.
- The FIFA11+ program reduces injury by 30%, with reported relative risk of 0.70 for lower limb injuries, highlighting the significant preventative importance of this warm-up program.
EPIDEMIOLOGY
There are currently 28 players on each of the Major League Soccer (MLS) teams, and during the 2013 to 2014 academic year, the National Federation of State High School Associations (NFHS) reported that 417,419 boys and 374,564 girls played high school soccer and the National Collegiate Athletic Association (NCAA) reported that 23,602 males and 26,358 females played collegiate soccer.5 As such, knee injuries in this population are a major concern for those involved in sports medicine. Several injuries occurring during soccer involve the lower extremity, particularly the knee.1 In fact, multiple reports estimate that up to 17.6% of soccer-related injuries presenting to the emergency room involved the knee.1,6-9 The majority of these injuries are noncontact injuries, although contact injuries do still occur.10,11
Risk factors for injuries in soccer may be non-modifiable (such as age and gender) and modifiable (such as level of conditioning, force, balance, and flexibility). Inadequate lower motor coordination may result in injury in the adolescent population, and advanced age >28 years in males and >25 years in females is considered as a high-risk factor for injury.12,13 Importantly, gender and age have been reported to play a significant role as risk factors for ACL injury.6 In fact, female players have a 3 to 5 times higher risk of significant knee injury, including ACL injuries, than male players.4,14-16 Preventative programs such as the FIFA 11+ program have been set forth to augment conditioning as part of managing the modifiable risk factors.
Like American football, playing on artificial turf has been questioned as a contributor to injury compared to playing on natural grass.17,18 In recent years, newer generations of artificial turf have been developed to more closely replicate the characteristics of natural grass. Meyers19 compared the incidence, mechanisms, and severity of match-related collegiate men’s soccer injuries on artificial turf and those on natural grass and demonstrated no significant difference in knee injuries between the 2 surfaces. This finding was consistent with previous studies that reported no difference in the incidence of knee injuries on either surface in women’s collegiate and elite-level soccer.15,20,21
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