Abstract
PurposeAnterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature.MethodsThis study is based on the prospective ‘ACL registry in German Football’ implemented in the 2014–15 season. Professional (1st–3rd league), semi-professional (4th–6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014–15 to the 2018–19 football season.ResultsOverall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%).ConclusionThis sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention.Level of evidenceII.
Highlights
Anterior cruciate ligament (ACL) ligament injuries are one of the most common types of football injuries at all levels of play and associated with severe mid-term and longterm effects
The ACL registries established in the above-mentioned countries include some sports-specific sub-analyses for specific types of sports such as football, they do not provide any prospective longitudinal data on ACL injuries sustained by a specific population such as football players, in particular according to the different football levels, which represents a huge gap of knowledge in this scientific field
Four hundred eighty three (50.4%) ACL injuries were registered in recreational amateur football leagues, 198 (20.7%) in professional and 277 (28.9%) in semi-professional football leagues
Summary
Anterior cruciate ligament (ACL) ligament injuries are one of the most common types of football injuries at all levels of play and associated with severe mid-term and longterm effects. The ACL registries established in the above-mentioned countries include some sports-specific sub-analyses for specific types of sports such as football, they do not provide any prospective longitudinal data on ACL injuries sustained by a specific population such as football players, in particular according to the different football levels, which represents a huge gap of knowledge in this scientific field. A prospective longitudinal cohort study by the UEFA (UEFA Injury Study) on the population of professional football players included seasonal investigations into the epidemiology of ACL injuries [7, 33, 35] but did not provide any data on the skill levels below the UEFA Champions League. In amateur and recreational football as the foundation of football with hundreds of millions of players worldwide, scientific registration of ACL injuries is still lacking completely [19, 34]
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