Anterior cruciate ligament injuries in football

Anterior cruciate ligament (ACL) injuries and football are clearly intertwined. ACL injuries are principally sustained when participating in pivoting activities and, as it is such a popular sport, football is consequently a major cause of these injuries. The flip side of this is of course that ACL injuries negatively affect the afflicted players’ potential to play the game. It is this relationship the present thesis attempts to elucidate.

In Study I, factors associated with a return to football after ACL reconstruction were examined in football players. The participants were asked about their return to football and knee symptoms during physical activity. Data were collected from Capio Artro Clinics local database regarding surgical information, patient-reported outcome measurements (PROMs), knee laxity and muscle strength. In the study, female gender, cartilage injury and knee pain during physical activity were found to be independent negative factors for returning to football after ACL reconstruction.

In Study II, a 10-year follow-up of football players from all levels in the Swedish National Knee Ligament Registry (SNKLR) was performed using a questionnaire to investigate how many players returned to play, what influenced their decision and whether there were any differences in additional ACL injuries (graft failure and/or contralateral ACL injury) between those who returned to play and those who did not. Fifty-four per cent of the football players returned to play after ACL reconstruction and, in two-thirds of those who did not return, the reason was knee related. Players who returned to football ran a significantly higher risk of sustaining further ACL injury.

In Study III, the effect of an ACL reconstruction for teenage football talents on their potential to continue as football players and become elite players at senior level was investigated. All players from the NEC (national elite camps) over six seasons were followed and data were collected from the SNKLR and the Swedish FA. As no significant differences were found between the ACL-reconstructed and uninjured players, it appears that ACL-reconstructive surgery in talented youth football players offers them the opportunity to become elite players as seniors and permits an activity level on a par with that of their uninjured peers.

In Study IV, an epidemiological survey was made of players who, on the website of the SNKLR, provided information on football-specific factors associated with their ACL injury. The study found that ACL injuries were more frequently sustained during games, 66%, than during practice, 25%. Knee control exercises to warm up were used by 31% of the female players and 16% of the males. Forty per cent of the players reported that they did not plan on returning to football. Teams changing coaches and players moving to a higher division appear to run an increased risk of ACL injury.

List of scientific papers

I. Factors associated with returning to football after anterior cruciate ligament reconstruction. Alexander Sandon, Suzanne Werner & Magnus Forssblad. Knee Surgery Sports Traumatolgy and Arthroscopy. 2015 Sep;23(9):2514-21.
https://doi.org/10.1007/s00167-014-3023-4

II. High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry. Alexander Sandon, Björn Engström & Magnus Forssblad. Artroscopy. 2020 Jan;36(1):189-195.
https://doi.org/10.1016/j.arthro.2019.05.052

III. Can Talented Youth Soccer Players Who Have Undergone Anterior Cruciate Ligament Reconstruction Reach the Elite Level? Alexander Sandon, Tor Söderström, Andreas Stenling, Magnus Forssblad. Am J Sports Med. 2021 Feb;49(2):384-390.
https://doi.org/10.1177/0363546520976651

IV. Increased occurrence of ACL injuries for football players in teams changing coach and for players going to a higher division. Alexander Sandon, Werner Krutsch, Volker Alt, Magnus Forssblad. Knee Surgery Sports Traumatology and Arthroscopy. 2021 May 13.
https://doi.org/10.1007/s00167-021-06604-w