Return to competitive football after major knee surgery: more questions than answers?

Despite significant advances in the diagnostics and treatment of knee injuries over the last decade, several challenges related to the subject "return to sport" remain largely unknown. For example, how should "return to sport" be defined precisely? What is the optimal timing and progression to enable a return to sport? Which criteria should be used during this process? What type of training is indicated? Which measurements can support the decision-making process? How do we optimally prepare athletes for competition without risking re-injury? This paper critically addresses these questions, and proposes a return to play model to prepare football players to compete after major knee surgery (anterior cruciate ligament reconstruction, cartilage repair). The goal is to re-integrate the player gradually into the game, taking into account his individual characteristics. Several evidence-based and empirical criteria are needed to plan and monitor the efficient return to competitive football. Injury-prevention education should be part of this process to maximise the chance of a durable career and decrease the risk of re-injury. However, because of the paucity of research on "return to sport", further research is more than warranted.

The prevalence of radiographic hip abnormalities in elite soccer players.

BACKGROUND: Hip injuries, both intra- and extra-articular, are becoming a more commonly recognized, diagnosed, and treated injury in athletes of all competitive levels. Our goal is to establish a previously undefined value in this athletic population--the prevalence of radiographic hip abnormalities in elite soccer athletes. PURPOSE: To provide a foundation for the future body of literature regarding hip pathologic abnormalities and "at-risk" hips in athletes of all ages and levels of participation. STUDY DESIGN: Descriptive epidemiology study. METHODS: We retrospectively reviewed the anteroposterior pelvis and frog-leg lateral radiographs of 95 elite male and female soccer players to determine the prevalence of hip abnormalities. Athletes with a history of hip or groin injuries were included. Multiple radiographic parameters were used to assess the presence of cam and pincer-type femoroacetabular impingement. Measurements were conducted by a blinded, sports medicine fellowship-trained orthopaedic surgeon with experience in treating hip disorders. RESULTS: In total, 72% (54/75) of male and 50% (10/20) of female players demonstrated some evidence of radiographic hip abnormality. Cam lesions were present in 68% (51/75) of men (76.5% [39/51] bilateral involvement) and 50% (10/20) of women (90% [9/10] bilateral involvement). Pincer lesions were present in 26.7% (20/75) of men and 10% (2/20) of women. The average male alpha angle overall was 65.6°. Cam-positive hips averaged 70.7°. The average female alpha angle overall was 52.9°, with cam-positive hips averaging 60.8°. CONCLUSION: The prevalence of radiographic hip abnormalities in elite soccer athletes is considerable, particularly in young male athletes. The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes.

Rehabilitation after Articular Cartilage Repair of the Knee in the Football (Soccer) Player.

BACKGROUND: Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to nonathletes. The management of chondral defects in the football player is complex and multifactorial. OBJECTIVE: The aim of this study is to provide an overview of the current strategies for rehabilitation after articular cartilage repair of the knee in the football player. DESIGN: A review of current literature and the scientific evidence for rehabilitation after articular cartilage repair of the knee. CONCLUSIONS: Articular cartilage repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after articular cartilage repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation, especially in the transition from therapy to performance care. It should be recognized that not all players will return to football after articular cartilage repair. The evidence base for rehabilitative practice after articular cartilage repair is increasing but remains sparse in areas.

Gender influences: the role of leg dominance in ACL injury among soccer players.

OBJECTIVE: This study intends to look at the role of leg dominance in anterior cruciate ligament (ACL) injury risk among soccer (football) athletes. The purpose of this study was to test the hypothesis that soccer players rupture the ACL of their preferred support leg more frequently than the ACL in their preferred kicking leg, particularly in non-contact injuries, despite differences in gender. DESIGN: Retrospective observational study. SETTING: Outpatient orthopaedic practice. PATIENTS: Subjects who had sustained an ACL injury due to direct participation in soccer. N=93 (41 male, 52 female). INTERVENTIONS: These noncontact injuries were sustained while playing soccer. RESULTS: For non-contact injuries, roughly half of the injuries occurred in the preferred kicking leg (30) and the contralateral leg (28). However, by gender, there was a significant difference in the distribution of non-contact injury, as 74.1% of males (20/27) were injured on the dominant kicking leg compared with 32% (10/31) of females (p<0.002). CONCLUSIONS: When limited to a non-contact injury mechanism, females are more likely to injure the ACL in their supporting leg, whereas males tend to injure their kicking leg. This research suggests that limb dominance does serve as an aetiological factor with regard to ACL injuries sustained while playing soccer. If follow-up studies confirm that females are more likely to injure their preferred supporting leg, future research should investigate the cause for this discrepancy, which could result from underlying gender-based anatomical differences as well as differences in neuromuscular patterns during cutting manoeuvres or kicking.

Prevention of anterior cruciate ligament injury in the female athlete.

The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high-risk population.