Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis

Abstract

Context: The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors’ knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. Objective: To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. Data Sources: A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. Study Selection: Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. Study Design: The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. Level of Evidence: Level 4. Data Extraction: Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. Results: The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. Conclusion: Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.

Rehabilitation of Soccer Players’ Knee Injuries: Cartilage Reconstruction, Anterior Cruciate Ligament Surgery, and Intensive Recovery—A Pilot Study

“…ACL and cartilage tissue reconstruction are surgical procedures often performed in soccer players for knee injuries. The knee plays a crucial role as one of the most vital joints in a soccer player's body and damage to the ACL or cartilage tissue can result in limited mobility and force the player to stop his sports career [36][37][38]. In this pilot study effects of follow-up after Hyalofast scaffold cartilage surgery combined with ACL reconstruction in the case of a professional athlete were presented.…”

“…Indeed, amidst the controversies surrounding the approach and selection of cartilage defect treatments, one undeniable fact remains: certain lesions necessitate repair to prevent further deterioration. Preserving the integrity and functionality of the affected joint is paramount, and appropriate treatment interventions are imperative to achieve this goal [38].…”

Addition of anterolateral ligament reconstruction to primary anterior cruciate ligament reconstruction could benefit recovery of functional outcomes

“…The anterior cruciate ligament (ACL) is commonly injured during sports activities, and ACL reconstruction (ACLR) is the current standard surgical treatment to regain knee joint stability and improve knee function 1 – 4 . Despite remarkably improved clinical outcomes following ACLR 5 , several recent studies reported that some patients still have difficulty returning to pre-injury sports participation levels after isolated ACLR 6 – 10 , possibly due to rotational knee instability at high levels of activity 11 . The addition of anterolateral ligament reconstruction (ALLR) to ACLR recently emerged as a potential solution 11 – 14 .…”

The risk factors for second anterior cruciate ligament (ACL) tear after ACL reconstruction

“…Finally, a systematic review and meta-analysis revealed that soccer players experienced high ACL injury rates after primary ACL reconstruction and demonstrated similar reinjury rates, consistent with previous literature of athletes who participated in high-demand pivoting sports. [ 9 ]…”