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The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Sport-specific, performance-based outcomes are increasingly used to improve evaluation of treatment efficacy in elite athletes; however, its usage in elite soccer may be limited. The purpose of this investigation is to (1) assess current outcome reporting in elite soccer; (2) identify any variability in reporting of outcomes; and (3) determine how sport-specific performance-based outcomes are utilized to assess treatment efficacy in elite soccer.

Methods

A systematic review of the Pubmed, MEDLINE, and Embase, Scopus, SportDiscus, CINAHL and HealthSource: Nursing databases was performed without limitation on publication year. Inclusion criteria were (1) reporting of outcomes after a (2) lower extremity injury in (3) elite soccer players. The study’s population, type of injury, return to play, as well as functional, objective, and sport-specific performance-based outcomes were extracted from each article. The methodological index for nonrandomized studies was used for quality assessment.

Results

Twenty-one studies were selected after application of the inclusion and exclusion criteria. Objective outcomes were reported by 6 (29%) studies, and 6 (29%) employed patient-reported outcomes. The visual analog scale, Lysholm, and Tegner scores were the most common patient-reported outcomes (PROs). Return to play was reported by 18 (86%) studies, and only 2 (10%) utilized sport-specific performance-based outcomes. Despite the majority of studies reporting return to play, variation was seen in the definitions, and 15 (71%) studies reported the activity level of the players at final follow-up.

Conclusion

Assessment of treatment efficacy is limited in elite athletes, and PROs lack the sensitivity to identify residual performance deficits after an injury. Although performance-based measures are available at the elite level, these outcomes were seldom used for evaluation of treatment efficacy.

Clinical relevance

When treating elite soccer players, patient-reported outcome measures lack the sensitivity to detect changes in patient function, thus performance-based metrics may be more efficacious in assessing return from injury in these patients.

Level of evidence

IV.

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Authors and Affiliations

  1. Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA

    William A. Zuke, Avinesh Agarwalla, Brian J. Cole, Nikhil N. Verma, Bernard R. Bach & Brian Forsythe

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Beatrice Go

  3. Jordan-Young Institute for Orthopaedic Surgery and Sports Medicine, Eastern Virginia Medical School, Virginia Beach, VA, USA

    Justin W. Griffin

Authors
  1. William A. Zuke
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  2. Avinesh Agarwalla
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  4. Justin W. Griffin
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  6. Nikhil N. Verma
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  7. Bernard R. Bach
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Corresponding author

Correspondence to Brian Forsythe.

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Conflict of interest

Dr. Verma is a board member for American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Society, Arthroscopy Association of North America, and is on the editorail board for Arthroscopy, Journal of Knee Surgery, SLACK Incorporated. Dr. Verma receives research support from Arthrex Inc, Arthrosurface, DJ Orthopaedics, Ossur, Athletic, CONMED Linvatec, Miomed, Smith and Nephew, and Mitek. Dr. Verma has stock options in Cymedica, Minivasive, Omeros. Dr. Verma receives publishing royalties from Arthroscopy, and Vindico Medical Orthopaedics-Hyperguide. Dr. Cole receives research support from Aseculap, Arthrex Inc, Geistlich, National Institute of Health, Sanofi-Aventis, and Zimmer, Dr. Cole is on the editorial board for the American Journal of Orthopaedics, American Journal of Sports Medicine, Arthroscopy, Cartillage, Journal of Bone and Joint Surgery, Journal of Shoulder and Elbow Surgery, and Journal of the American Academy of Orthopaedic Surgeons. Dr. Cole has stock options in Aqua Boom, Biometrix, Giteliscope, Ossio, and Regintis, as well as receives material support from Tournier. Dr. Cole is a board member for Arthroscopy Association of North America, and International Cartilage Repair Society. Dr. Cole receives IP royalties from Elsevier and DJ Orthopaedics, and Dr. Cole is a paid consultant for Flexion, Regentis, and Smith and Nephew. Dr. Bach has received publishing royalties from SLACK Incorporated as well as research support from Arthrex Inc, CONMED Linvatech, DJ Orthopaedics, Ossur, Smith and Nephew and Tornier. Dr. Forsythe receives paid royalties from Elsevier, research support from Arthrex Inc, Stryker, fellowship support from Ossur and Smith and Nephew, and has stock options in Jace Medical.

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Zuke, W.A., Agarwalla, A., Go, B. et al. The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review. Knee Surg Sports Traumatol Arthrosc 26, 3109–3117 (2018). https://doi.org/10.1007/s00167-018-5032-1

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