Return to sport after anterior cruciate ligament reconstruction in professional soccer players

The Knee (Impact Factor: 1.94). 06/2014; 21(3). DOI: 10.1016/j.knee.2014.02.005


The purpose of the study is to investigate time to return to sport and rate of professional sport activity in a homogenous group of competitive soccer players 4 years after anterior cruciate ligament (ACL) reconstruction and rehabilitation.

Twenty-one male professional soccer players (mean age 22.9 ± 5.4 years) undergone non-anatomical double-bundle autologous hamstrings ACL reconstruction and followed the same rehabilitative protocol. Clinical evaluation was performed preoperatively and at 3, 6 and 12-month follow-up. Data regarding return to train and official match, sport activity, complications and revision surgeries were collected at 4-year follow-up.

Laxity test (KT-2000) and total KOOS mean score resulted significantly improved from preoperative status to the 12-month follow-up (p < 0.0001). The KOOS mean value showed a significant progressive improvement form preoperative status to 6-month follow-up (p = 0.0010) as well, while the values collected at 6 and 12-month follow-up resulted comparable (p = 0.2349). They return to official match 186 ± 53 days after surgery. After 12 months, 95% came back to the same activity level performed before injury. Four years after ACL reconstruction, 15 patients (71%) were still playing competitive soccer. One patient (5%) underwent ACL failure and subsequent revision.

The ACL reconstruction with presented technique followed by patient-tailored rehabilitation, allowed 95% and 62% professional male soccer players to return to the same sport activity 1 year and 4 years after surgery respectively. However, 71% were still able to play competitive soccer at final follow-up. Clinical scores were restored after 6 months.

Level of evidence
IV, case series.

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Available from: Stefano Zaffagnini, Jan 24, 2016
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    • "and Dvorak, 2007). Among these injuries, female players or staff on these teams indicate that knee injuries, particularly anterior cruciate ligament (ACL) tears, occur at a high rate, and ACL injuries require an average of 186 days of rehabilitation before resuming training and competition (Zaffagnini et al., 2014). ACL injuries in soccer are more frequent in women than in men (Arendt and Dick, 1995; Bjordal et al., 1997; Harmon and Dick, 1998; Powell and Barber-Foss, 2000). "
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    ABSTRACT: Athletes with non-contact anterior cruciate ligament tears have common features in the sagittal plane; namely, the body's center of mass (COM) is located posterior to the base of support, the trunk and knee joints are extended, and the hip angle is flexed. However, the relationships among these variables have not been assessed in field-based movements. This study sought to determine relationships between distances from the COM to the base of support and the trunk, hip, and knee positions in women while playing soccer. Sixty events (29 single-leg landing and 31 single-leg stopping events) were analyzed using two-dimensional video analysis. The relationships among the measurement variables were determined using the Pearson's product-moment correlation coefficient, and stepwise multiple linear regression models were used to explore the relationships between the COM position and the kinematic variables. The distance from the COM to the base of support displayed a moderate negative relationship with the trunk angle (r = -0.623, p < .0001, r(2) = 0.388) and a strong positive relationship with the limb angle (r = 0.869, p < .0001, r(2) = 0.755). The limb, knee, and trunk angles were selected in the best regression model (adjusted r(2) = 0.953, p < .0001, f(2) = 20.277). These findings suggest that an increased trunk angle and a decreased limb angle at initial contact are associated with a safer COM position. Neuromuscular training may be useful for controlling the trunk and lower limb positions during dynamic activities.
    Full-text · Article · Mar 2015 · Journal of Human Kinetics
    • "The most recent report available in the literature concerning tibial HG attachment preservation is related to a case series of 21 professional soccer players operated by non-anatomic double-bundle ACL reconstruction followed by patient-tailored rehabilitation. The procedure permitted a faster sport resumption (return to official matches 186 ± 53 days after surgery) with respect to the other case series available in the literature and dealing with top-level athletes allowing 95 and 62 % of the professional male soccer players to return to the same sport activity 1 and 4 years after surgery, respectively [31]. "
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    ABSTRACT: Hamstring graft (HG) used in anterior cruciate ligament (ACL) reconstruction undergoes a biological modification process called "ligamentization" in the early postoperative period that proceeds through three different phases: an early graft-healing phase with central graft necrosis, a phase of proliferation, and finally, a ligamentization phase toward the properties of the intact ACL. The fastening of this process could result in more aggressive rehabilitation protocols as well as faster sport resumption. A recent literature supports the preservation of HG tibial attachment in order to enhance "ligamentization" process. Aim of this literature review is to describe all the techniques described that spare HG tibial insertion and the obtained results in order to evaluate evidence that would substantiate the maintenance of HG tibial insertion in ACL reconstruction. A search was performed using the following keywords "ACL reconstruction" in combination with "hamstrings," "hamstrings insertion," "tibial insertion," "ligamentization," and "over the top"; 18 articles were found to be relevant. Among these, eight randomized clinical trials (RCTs) were found. The RCT analyzed presented a high number of biases regarding the analyzed topic, thus making impossible to draw definitive evidences to validate HG tibial insertion sparing in ACL reconstruction. Despite the satisfactory results in many clinical series and the promising results in anatomic and animal studies, well-designed prospective clinical trials with large cohort of patients associated with MRI evaluation are mandatory to assess the beneficial effects of HG attachment preservation in ACL reconstruction.
    No preview · Article · Feb 2015 · MUSCULOSKELETAL SURGERY
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    ABSTRACT: Background: The treatment and rehabilitation procedures of anterior cruciate ligament (ACL) injuries in elite soccer players are controversial. Points of debate include surgical timing, technique, graft choice, rehabilitation, and return-to-sport criteria and timing.
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