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Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review.

ABSTRACT: Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.

SUBMITTER: Olivares-Jabalera J

PROVIDER: S-EPMC8704173 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury. HYPOTHESIS:Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league. STUDY DESIGN:Descriptive epidemiological study. LEVEL OF EVIDENCE:Level 4. METHODS:Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated. RESULTS:There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003). CONCLUSION:The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league. CLINICAL RELEVANCE:Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors.

Project description:BackgroundConsiderable variability exists in return-to-play rates after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) among National Football League (NFL) players of different positions.Purpose/hypothesisThe purpose of this study was to compare return-to-play and performance levels by position in NFL players after ACLR. It was hypothesized that (1) ACL injuries have significant effects on the careers of NFL players, including return to play and performance, and (2) players of certain positions that involve relatively less pivoting and cutting perform better after ACLR.Study designDescriptive epidemiology study.MethodsAll NFL players who underwent ACLR between 2013 and 2018 were identified using the FantasyData injury database. Player characteristics, snap count, games played, games started, and performance metrics were collected for 3 years before and after injury using the Pro Football Reference database. Performance was measured using an approximate value (AV) algorithm to compare performance across positions and over time. Nonparametric tests were used to compare the pre- and postinjury data and the percentage change in performance between different positions.ResultsOverall, 312 NFL players were included in this study, and 174 (55.8%) returned to play. Of the eligible players, only 28.5% (n = 59/207) remained in the league 3 years postinjury. Within the first 3 years postinjury, players played in fewer games (8.7 vs 13.7; P < .0001), started in fewer games (3.0 vs 8.3; P < .0001), had lower AVs (1.5 vs 4.3; P < .0001), and had decreased snap counts (259.0 vs 619.0; P < .0001) compared with preinjury. Quarterbacks were most likely to return to play (92.9% vs 53.7%; P = .0040) and to return to performance (2% vs 50% decrease in AV; P = .0165) compared with the other positions. Running backs had the largest decrease in AV (90.5%), followed by defensive linemen (76.2%) and linebackers (62.5%).ConclusionThe study findings indicated that NFL players are severely affected by ACL injury, with only 28.5% still active in the league 3 years after the injury. Running backs, defensive linemen, and linebackers performed the worst after injury. Quarterbacks were most likely to return to play and had superior postinjury performance compared with the other positions.

Project description:BackgroundThe available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR.ObjectiveThe aim of this systematic review was to examine RTP and the performance of soccer players after ACLR.MethodsThree electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS).ResultsDatabases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years.ConclusionAlthough a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.

Project description:ObjectiveThe aim of this study was to compare the pressure pain threshold and muscle architecture after an anatomic single bundle reconstruction with quadriceps tendon and hamstring tendon autografts of the anterior cruciate ligament in competitive soccer players. We hypothesized that both procedures will obtain similar outcomes.MethodsFifty-one participants were enrolled in this secondary analysis of a randomized controlled trial and were categorised into two groups: quadriceps tendon (QT) group (23 men and 3 women; mean age 18.7 ± 3.6; BMI 23.0 ± 2.2) or hamstring tendon (HT) group (16 men and 9 women; mean age 19.2 ± 3.6 BMI 23.5 ± 3.5). Both groups followed the same rehabilitation staged protocol. Pressure pain threshold (PPT), as a measure of perceived pain, was obtained in several points of quadriceps and hamstring muscles. Ultrasound imaging measurements were obtained in quadriceps tendon and knee cartilage thickness. Four measurements were taken in this study: baseline, 1, 3, 6, and 12 months after the anterior cruciate ligament (ACL) reconstruction.ResultsThe analysis of PPT did not find significant differences in both groups × interaction time in the points evaluated: epicondyle (QT = 421.1 ± 184.1 vs HT = 384.7 ± 154.1 kPa), vastus lateralis (QT = 576.2 ± 221.3 vs HT = 560.1 ± 167.7 kPa), vastus medialis (QT = 544.7 ± 198.8 vs HT = 541.1.1 ± 181.77 kPa), patellar tendon (QT = 626.3 ± 221.1 vs HT = 665.0 ± 205.5 kPa), QT (QT = 651.1 ± 276.9 vs HT = 660.0 ± 195.2 kPa). (QT = 667.8 ± 284.7 vs HT = 648.2 ± 193.4 kPa) injured knee (all P > 0.05). The results of ultrasound imaging did not show significant differences in both groups × interaction time in the thickness of the QT (QT = 9.9 ± 2.4 vs HT = 9.4 ± 1.7 kPa) and patellar cartilage (QT = 3.2 ± 0.6 vs HT = 3.2 ± 0.4 kPa) (P > 0.05).ConclusionA QT autograft produces similar results to a HT autograft in ACL reconstructions in terms of pressure pain threshold and ultrasound muscle architecture during the 1-year follow-up.Level of evidenceLevel I, Therapeutic Study.

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Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review.

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