Concomitant Injuries Associated With ACL Rupture in Elite Professional Alpine Ski Racers and Soccer Players: A Comparative Study With Propensity Score Matching Analysis

Abstract

Background: For elite professional soccer players and alpine skiers, injuries associated with anterior cruciate ligament (ACL) rupture, such as meniscal, cartilage, or collateral ligament lesions, could result in a delayed return to sport compared with isolated ACL injury. Purpose/Hypothesis: The purpose of the study was to provide a detailed description of associated injuries at the time of primary ACL reconstruction in elite soccer players and alpine skiers. It was hypothesized that soccer players and skiers would present different typical injury patterns due to different injury mechanisms. Study Design: Cohort study; Level of evidence, 3. Methods: Surgical reports and arthroscopic images of elite professional soccer players and alpine skiers who underwent primary ACL reconstruction at a single institution between January 2010 and June 2022 were analyzed retrospectively. The presence and location of multiligamentous injury, meniscal tears, and chondral lesions were compared between the athlete groups. A propensity score matching analysis with 1:1 ratio was performed between skiers and soccer players to limit the effect of selection bias. Results: Included were ACL reconstruction data representative of 37 soccer players and 44 alpine skiers. Meniscal pathology was found in 32 (86%) soccer players and 30 (68%) skiers. Chondral injuries were reported in 11 (30%) soccer players and 15 (34%) skiers. Results of the propensity score matching analysis in 15 pairs of soccer players and skiers indicated that soccer players had a significantly higher rate of medial meniscal injuries (73% vs 27%; P = .03) and lateral posterior root tears (33% vs 0%; P = .04) compared with skiers. Conclusion: A higher prevalence of combined chondral and meniscal injuries versus isolated ACL injuries was observed in both groups of athletes. Professional soccer players were characterized by higher prevalence of medial meniscal tears and lateral posterior root lesions compared with professional alpine skiers.

Meniscus Injuries in Soccer

“…34 These described scenarios and mechanisms could also theoretically lead to meniscus tears as the prevalence of concomitant meniscal pathology in soccer players who rupture their ACLs has been found to be as high as 86%. 35 Though understudied, repetitive hyperextension with kicking may also cause a specific pattern of meniscal injury in soccer players, as numerous case series have, since, demonstrated a specific pattern of pathology in the anterior horn of the lateral meniscus in soccer players. [36][37][38]…”

“…While there are no studies examining mechanisms of isolated meniscus tears in soccer players specifically, a systematic review found that knee valgus loading when “pressing and tackling,” “being tackled,” “regaining balance after kicking,” or “landing from a jump” were the most common mechanisms of ACL tears 34 . These described scenarios and mechanisms could also theoretically lead to meniscus tears as the prevalence of concomitant meniscal pathology in soccer players who rupture their ACLs has been found to be as high as 86% 35 . Though understudied, repetitive hyperextension with kicking may also cause a specific pattern of meniscal injury in soccer players, as numerous case series have, since, demonstrated a specific pattern of pathology in the anterior horn of the lateral meniscus in soccer players 36–38 …”

Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra‐articular internal tibial rotation in ACL‐deficient knees based on magnetic resonance imaging

“…Anterior cruciate ligament (ACL) rupture represents a serious injury for athletes [10]. It could be associated to meniscal, cartilage and collateral ligament lesions and represent a common cause of rotatory knee instability [9,13,33]. The ACL provides restraint to anterior translation and internal rotation of the tibia relative to the femur [16,38,50].…”