Summary
Appropriate treatment of ACL and MCL injuries in elite soccer and rugby results in excellent RTP rates and career longevity which is comparable to that of uninjured matched controls.
Abstract
Aim
The primary aim of this study was to determine the effect on career longevity of professional soccer and rugby players after primary ACLR and associated MCL injury, treated with operative or non-operative management, by comparing them with an uninjured, matched, control cohort. Secondary aims were to compare minutes played, match appearances and league level of performance. The hypothesis was that professional soccer and rugby players will have a shorter career, play less and at a lower level after ACL and associated MCL injury than uninjured, matched controls.
Methods
A consecutive series of primary ACLR and combined ACLR plus MCL reconstructions in professional soccer and rugby players, performed by 2 specialist knee surgeons between 2015 and 2022, were retrospectively reviewed.
Players were included if they underwent primary ACLR with MRI evidence of MCL injury, which was treated operatively or non-operatively. Players were excluded if they had injuries to any other ligament, either concurrently or previously.
Match appearances, minutes played and league level for the 12 months prior to injury were extracted from publicly available data. ACL & MCL injured players were matched to 5 uninjured players who were playing at the time of the players injury. They were matched by age, sport, playing position, league, match appearances and minutes played.
Results
Associated MCL injuries were present in 141 primary ACL reconstructions undertaken in elite soccer and rugby players between 2015 and 2022. Ninety-four ( 54, soccer and 30 rugby) were eligible for inclusion in the study. Fifty-eight (61.7%) players had ACLR with non-operative treatment of the MCL injury and of these 40(69.0%) were soccer players. 36 players had ACLR with operative treatment of the MCL and of these 22 (61.1%) were rugby players. Eighty-five (90.4%) ACLR + MCL injured players (92.6% in soccer and 87.5% in rugby) returned to professional sport at a mean time of 11.6 ± 4.1 months. However, as 38 (8.5%) of the uninjured, control players stopped playing within 11 months of the equivalent operation date the playing rates between the injured and uninjured groups did not significantly differ at this time. Mean career length post operation for those that RTP was 5.46 years and in the control group it was 5.56 years (p= 0.80). Median career length, controlling for age, sport and level was 7.07 years in the uninjured group compared to 6.68 years in the ACLR and MCL injury group (p=0.36). Twenty-eight (29.8%) of ACLR+MCL players were still playing at the censor date of 31st December 2024 compared to 160 (36.0%) in the control group (p=0.52). Kaplan-Meier curves demonstrate no significant differences in the probability of continuing to compete professionally after ACLR and MCL injury between injured players and their matched controls, regardless of MCL treatment or sport played.
Conclusion
Appropriate treatment of ACL and MCL injuries in elite soccer and rugby results in excellent RTP rates and career longevity. Career longevity is comparable to that of uninjured matched controls.