Summary
After ACL reconstruction in elite soccer players, more than 92.3% return to sport and of these almost 80.1% return to their pre-injury level with a re-rupture rate of 8.2% and a mean return to sport at 263.20 days. In recent years, the return to professional soccer has been significantly slower than in the past by increasing by more than 40 percent.
Abstract
Background
Elite soccer players have a higher return to play (RTP) rate than other sports, ranging from 77% to 95%. The average time to return to play ranged from 6 to 13 months. The aim of this systematic review and meta-analysis was to compare return to play, time to return to play, level of return to play and re-injury rate in professional soccer players from three different time periods. The secondary aim was to to evaluate temporal trends in RTS duration following ACL injury among elite male footballers between 2005 and 2020 using Trasnfermarkt, while the third aim was to investigate whether longer RTS durations were associated with reduced risk of subsequent ACL injuries. .
Methods
Four different outcome measures (RTS, time to RTS, level of RTS and re-rupture rate) were extracted and meta-analyzed from all included studies and compared from three different time periods (before 2017, 2017-2021, after 2022). For Transfermarkt data the primary exposure variable was RTS duration, defined as the number of days between the date of first ACL injury and the date of return to official competition. The primary outcome was ACL reinjury (yes/no).
Results
92.3% [95% CI 88.8–95.2] of elite soccer players returned to sport. No differences were found between the three different time periods (p>0.05). 80.1% [95% CI 65.5–91.5] of elite soccer players returned to their pre-injury level. Meta-analysis showed no difference (p>0.05) in the level of return to play rates between the different time periods, ranging from 75.6% (2022-2025) to 85.3% (2011-2016). ACL rupture was recorded in 146 (8.77%) of the 1663 elite soccer players. Meta-analysis showed no difference (p>0.05) in re-rupture rates between the different time periods, ranging from 10.4% (2017-2021) to 4.5% (2011-2016). Return to play rates ranged from 75.6% (2022-2025) to 85.3% (2011-2016). The mean time to return to play was estimated to be 263.20 days [95% CI 238.79 – 287.61]. The period 2022-2025 showed a lower return to play (295.06 days [95% CI 261.81–328.30]) compared to 2011-2016 (203.51 days [95% CI 147.73–259.29];p=0.006). For Transfermarkt data 728 players sustained only one ACL injury, whereas 134 players (15.5%) suffered two or more ACL injuries, either ipsilateral or contralateral. The age at reinjury remained consistent across the three time periods, with a mean of 25.2±4.1 years (p=0.55). The reinjury rate increased from 9.0% in 2005–2010 to 17.9% and then remained relatively stable from that to 2010–2015, and 16.4% in 2015–2020 (p = 0.031). There was a progressive increase in mean RTS duration from 196.7±50.9 days in 2005–2010 to 219.9±67.4 days in 2015–2020.
Conclusions
After ACL reconstruction in elite soccer players, more than 92.3% return to sport and of these, almost 80.1% return to their pre-injury level, with a re-rupture rate of 8.2% and an average return to sport at 263.20 days. In recent years, the return to professional soccer has been significantly slower than in the past, with an increase of more than 40 percent while not significantly decreasing the re-rupture rates.