Skip to main content
SpringerLink
Log in

Increase in ACL and PCL injuries after implementation of a new professional football league

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

Abstract

Purpose

In the season 2008–2009, a third professional football league was established in Germany. This study analysed the influence of increased training and playing intensity on severe knee injuries in football players.

Methods

In a prospective controlled one-season trial, injury incidence and injury patterns of players of the newly established professional football league were analysed, particularly with regard to ruptures of the anterior (ACL) and posterior (PCL) cruciate ligaments. Players of the highest amateur level served as a control group.

Results

Four hundred and eight players of 24 teams were allocated to two groups. The overall training exposure was significantly (p < 0.001) higher in the new professional league (335.3 h per player) than at the amateur level (286.6 h per player). Players at both levels showed similar overall injury rates and injury patterns. However, players in the professional league had a significantly higher (p = 0.04) incidence of ACL and PCL injuries, than players at the amateur level. More than 90 % of all ACL and PCL ruptures in both groups were sustained by players, who had played at least one level lower in the previous season. In addition, injuries of players who had sustained repeat injuries over the season were more severe.

Conclusion

The introduction of a new professional football league increased the training and playing intensity of players as well as the number of ACL and PCL ruptures. A specific injury prevention concept, particularly for players facing rapidly increasing training and playing intensity, seems to be mandatory.

Level of evidence

Prospective controlled cohort study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alentorn-Geli E, Myer GD, Silvers HJ et al (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17:705–729

    Article  PubMed  Google Scholar 

  2. Arnason A, Gudmundsson A, Dahl HA et al (1996) Soccer injuries in Iceland. Scand J Med Sci Sports 6:40–45

    Article  CAS  PubMed  Google Scholar 

  3. Arnason A, Sigurdsson SB, Gudmundsson A et al (2004) Risk factors for injuries in football. Am J Sports Med 32:5S–16S

    Article  PubMed  Google Scholar 

  4. Bjordal JM, Arnöy F, Hannestad B et al (1997) Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 25:341–345

    Article  CAS  PubMed  Google Scholar 

  5. Carraffa A, Cerulli G, Projetti M et al (1996) Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 4:19–21

    Article  Google Scholar 

  6. Chomiak J, Junge A, Peterson L et al (2000) Severe injuries in football players. Influencing factors. Am J Sports Med 28:S58–S68

    Article  CAS  PubMed  Google Scholar 

  7. Ekstrand J, Hägglund M, Walden M (2011) Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 45:553–558

    Article  CAS  PubMed  Google Scholar 

  8. Engebretsen AH, Myklebust G, Holme I et al (2008) Prevention of injuries among male soccer players. A prospective randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med 36:1052–1060

    Article  PubMed  Google Scholar 

  9. Faude O, Meyer T, Federspiel B et al (2009) Injuries in elite German football—a media-based analysis. Dtsch Z Sportmed 60:139–144

    Google Scholar 

  10. Fuller CW, Ekstrand J, Junge A et al (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 40:193–201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Garraway WM, Lee AJ, Hutton SJ et al (2000) Impact of professionalism on injuries in rugby union. Br J Sports Med 34:348–351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Griffin L, Agel J, Albohm M et al (2000) Non-contact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150

    Article  CAS  PubMed  Google Scholar 

  13. Hägglund M, Walden M, Bahr R et al (2005) Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med 39:340–346

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hägglund M, Walden M, Ekstrand J (2003) Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001. Scand J Med Sci Sports 13:364–370

    Article  PubMed  Google Scholar 

  15. Hägglund M, Walden M, Ekstrand J (2005) Injury incidence and distribution in elite football—a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15:21–28

    Article  PubMed  Google Scholar 

  16. Hägglund M, Walden M, Ekstrand J (2006) Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med 40:767–772

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hägglund M, Walden M, Ekstrand J (2009) UEFA injury study—an injury audit of European Championship 2006 to 2008. Br J Sports Med 43:483–489

    Article  PubMed  Google Scholar 

  18. Hawkins RD, Hulse MA, Wilkinson C et al (2001) The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 35:43–47

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Klügl M, Shrier I, Shultz R et al (2010) The prevention of sport injury: an analysis of 12.000 published manuscripts. Clin J Sport Med 20:407–412

    Article  PubMed  Google Scholar 

  20. Kucera KL, Marshall SW, Kirkendall DT et al (2005) Injury history as a risk factor for incident injury in youth soccer. Br J Sports Med 39:462–466

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lundblad M, Walden M, Magnusson H, Karlsson J, Ekstrand J (2013) The UEFA injury study: 11-year data concerning 346 injuries and time to return to play. Br J Sports Med 47:759–762

    Article  PubMed  Google Scholar 

  22. Mandelbaum BR, Silvers HJ, Watanabe DS et al (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 33:1003–1010

    Article  PubMed  Google Scholar 

  23. Mihata LC, Beutler AI, Boden BP (2006) Comparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players. Implications for anterior cruciate ligament mechanism and prevention. Am J Sports Med 34:899–904

    Article  PubMed  Google Scholar 

  24. Mohr M, Krustrup P, Bangsbo J (2003) Match performance of high-standard soccer players with special reference to development of fatigue. J Sports Sci 21:519–528

    Article  PubMed  Google Scholar 

  25. Morgan BE, Oberlander MA (2001) An examination of injuries in major league soccer. The inaugural season. Am J Sports Med 29:426–430

    CAS  PubMed  Google Scholar 

  26. Peterson L, Junge A, Chomiak J et al (2000) Incidence of football injuries and complaints in different age groups and skill-level groups. Am J Sports Med 28:S51–S57

    Article  CAS  PubMed  Google Scholar 

  27. Rochcongar P, Laboute E, Jan J et al (2009) Ruptures of the anterior cruciate ligament in soccer. Int J Sports Med 30:372–378

    Article  CAS  PubMed  Google Scholar 

  28. Roi GS, Nanni G, Tencone F (2006) Time to return to professional soccer matches after ACL reconstruction. Sport Sci Health 1:142–145

    Article  Google Scholar 

  29. Roos H (1998) Are there long-term sequelae from soccer? Clin Sports Med 17:819–831

    Article  CAS  PubMed  Google Scholar 

  30. Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123:186–191

    CAS  PubMed  Google Scholar 

  31. Söderman K, Pietilä T, Alfredson H et al (2002) Anterior cruciate ligament injuries in young female playing soccer at senior levels. Scand J Med Sci Sports 12:65–68

    Article  PubMed  Google Scholar 

  32. Soligard T, Myklebust G, Steffen K et al (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469

    Article  PubMed  PubMed Central  Google Scholar 

  33. Stolen T, Chamari K, Castagna C et al (2005) Physiology of soccer: an update. Sports Med 35:501–536

    Article  PubMed  Google Scholar 

  34. Toritsuka Y, Horibe S, Hiro-Oka A, Mitsuoka T, Nakamura N (2004) Conservative treatment for rugby football players with an isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 12:110–114

    Article  CAS  PubMed  Google Scholar 

  35. Tumilty D (1993) Physiological characteristics of elite soccer players. Sports Med 16:80–96

    Article  CAS  PubMed  Google Scholar 

  36. Walden M, Hägglund M, Magnusson H et al (2011) Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc 19:11–19

    Article  PubMed  Google Scholar 

  37. Walden M, Hägglund M, Werner J et al (2011) The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surg Sports Traumatol Arthrosc 19:3–10

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was conducted by the FIFA Medical Centre of Excellence in Regensburg. We would like to thank all participating teams of the 3rd professional football league (3. Liga) and the highest amateur leagues (Regionalliga Süd, Regionalliga West, Regionalliga Nord und Nordost) of the season 2008–2009 in Germany. The Centre of Clinical Studies at the University Medical Centre Regensburg in Germany (Director: Professor Dr. Michael Koller) provided statistical and linguistic support and was responsible for the data management.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Werner Krutsch, Johannes Zellner, Christian Pfeifer, Michael Nerlich & Peter Angele

  2. Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany

    Florian Zeman

  3. sporthopaedicum Straubing/Regensburg, Regensburg, Germany

    Peter Angele

Authors
  1. Werner Krutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian Zeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Zellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Pfeifer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Nerlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Angele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner Krutsch.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krutsch, W., Zeman, F., Zellner, J. et al. Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surg Sports Traumatol Arthrosc 24, 2271–2279 (2016). https://doi.org/10.1007/s00167-014-3357-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3357-y

Keywords

Search

Navigation