Higher Risk of ACL Rupture in Amateur Football Compared to Professional Football: 5-year Results of the 'Anterior Cruciate Ligament-registry in German Football'

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 Sep 15

PMID 34524500

Citations 13

Authors

Dominik Szymski

Leonard Achenbach

Johannes Zellner

Johannes Weber

Matthias Koch

Florian Zeman

Gunnar Huppertz

Christian Pfeifer

Volker Alt

Werner Krutsch

Affiliations

Soon will be listed here.

Abstract

Purpose: Anterior 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.

Methods: This 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.

Results: Overall, 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%).

Conclusion: This 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 Evidence: II.

Citing Articles

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Bialy M, Wilczynski B, Forelli F, Hewett T, Gnat R Cureus. 2025; 16(12):e75846.

PMID: 39822459 PMC: 11738117. DOI: 10.7759/cureus.75846.

Anterior Cruciate Ligament Reconstruction with LARS Synthetic Ligament: Outcomes and Failures.

Moretti L, Garofalo R, Cassano G, Geronimo A, Reggente N, Piacquadio F J Clin Med. 2025; 14(1.

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High incidence of anterior cruciate ligament injuries in professional men's handball: Analysis of the 'ACL registry in German Sports' over seven consecutive seasons.

Resch T, Krutsch W, Weber J, Krueckel J, Hartz F, Alt V J Exp Orthop. 2024; 12(1):e70132.

PMID: 39737425 PMC: 11683772. DOI: 10.1002/jeo2.70132.

Increased rate of injuries to the anterior cruciate ligament in amateur soccer players after the COVID-19 pandemic lockdown.

Memmel C, Krutsch W, Weber J, Huber L, Kerschbaum M, Rupp M Arch Orthop Trauma Surg. 2024; 144(9):4319-4324.

PMID: 39277554 PMC: 11564296. DOI: 10.1007/s00402-024-05531-y.

Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology and Details of Return to Sports.

Bezuglov E, Malyakin G, Emanov A, Baranova I, Stepanov I, Goncharov E Orthop J Sports Med. 2024; 12(8):23259671241261957.

PMID: 39131096 PMC: 11307334. DOI: 10.1177/23259671241261957.

References

Della Villa F, Hagglund M, Della Villa S, Ekstrand J, Walden M . High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study. Br J Sports Med. 2021; 55(23):1350-1356. PMC: 8606446. DOI: 10.1136/bjsports-2020-103555. View

Szymski D, Koch M, Zeman F, Zellner J, Achenbach L, Bloch H . Lessons from establishing a football-specific registry of anterior cruciate ligament injuries - data collection and first epidemiological data. Sci Med Footb. 2022; 6(4):446-451. DOI: 10.1080/24733938.2021.1991583. View

Prentice H, Lind M, Mouton C, Persson A, Magnusson H, Gabr A . Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med. 2018; 52(11):716-722. DOI: 10.1136/bjsports-2017-098674. View

Krutsch W, Zeman F, Zellner J, Pfeifer C, Nerlich M, Angele P . Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surg Sports Traumatol Arthrosc. 2014; 24(7):2271-9. DOI: 10.1007/s00167-014-3357-y. View

Krutsch V, Grechenig S, Loose O, Achenbach L, Zellner J, Striegel H . Injury Analysis in Professional Soccer by Means of Media Reports - Only Severe Injury Types Show High Validity. Open Access J Sports Med. 2020; 11:123-131. PMC: 7431944. DOI: 10.2147/OAJSM.S251081. View

Krutsch V, Clement A, Heising T, Achenbach L, Zellner J, Gesslein M . Influence of poor preparation and sleep deficit on injury incidence in amateur small field football of both gender. Arch Orthop Trauma Surg. 2019; 140(4):457-464. DOI: 10.1007/s00402-019-03261-0. View

Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S . Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. 2020; 54(23):1423-1432. DOI: 10.1136/bjsports-2019-101247. View

Hagglund M, Walden M, Bahr R, Ekstrand J . Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med. 2005; 39(6):340-6. PMC: 1725241. DOI: 10.1136/bjsm.2005.018267. View

Krutsch W, Lehmann J, Jansen P, Angele P, Fellner B, Achenbach L . Prevention of severe knee injuries in men's elite football by implementing specific training modules. Knee Surg Sports Traumatol Arthrosc. 2019; 28(2):519-527. DOI: 10.1007/s00167-019-05706-w. View

10.

Tabben M, Eirale C, Singh G, Al-Kuwari A, Ekstrand J, Chalabi H . Injury and illness epidemiology in professional Asian football: lower general incidence and burden but higher ACL and hamstring injury burden compared with Europe. Br J Sports Med. 2021; 56(1):18-23. DOI: 10.1136/bjsports-2020-102945. View

11.

Ekstrand J, Hagglund M, Walden M . Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2009; 45(7):553-8. DOI: 10.1136/bjsm.2009.060582. View

12.

Walden M, Hagglund M, Magnusson H, Ekstrand J . ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med. 2016; 50(12):744-50. DOI: 10.1136/bjsports-2015-095952. View

13.

Mohtadi N, Chan D . Return to Sport-Specific Performance After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Am J Sports Med. 2017; 46(13):3307-3316. DOI: 10.1177/0363546517732541. View

14.

Garcia-Luna M, Cortell-Tormo J, Garcia-Jaen M, Ortega-Navarro M, Tortosa-Martinez J . Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players. Int J Environ Res Public Health. 2020; 17(15). PMC: 7432391. DOI: 10.3390/ijerph17155608. View

15.

Achenbach L, Loose O, Laver L, Zeman F, Nerlich M, Angele P . Beach handball is safer than indoor team handball: injury rates during the 2017 European Beach Handball Championships. Knee Surg Sports Traumatol Arthrosc. 2018; 26(7):1909-1915. DOI: 10.1007/s00167-018-4907-5. View

16.

Walden M, Hagglund M, Ekstrand J . Time-trends and circumstances surrounding ankle injuries in men's professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013; 47(12):748-53. DOI: 10.1136/bjsports-2013-092223. View

17.

Wang L, Zeng N, Yan Z, Li J, Ni G . Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther. 2020; 22(1):57. PMC: 7092615. DOI: 10.1186/s13075-020-02156-5. View

18.

Ekstrand J, Krutsch W, Spreco A, Van Zoest W, Roberts C, Meyer T . Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study. Br J Sports Med. 2019; 54(7):421-426. PMC: 7146935. DOI: 10.1136/bjsports-2019-100666. View

19.

Loose O, Fellner B, Lehmann J, Achenbach L, Krutsch V, Gerling S . Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football. Knee Surg Sports Traumatol Arthrosc. 2018; 27(3):978-984. DOI: 10.1007/s00167-018-5119-8. View

20.

Koch M, Zellner J, Berner A, Grechenig S, Krutsch V, Nerlich M . Influence of preparation and football skill level on injury incidence during an amateur football tournament. Arch Orthop Trauma Surg. 2015; 136(3):353-60. DOI: 10.1007/s00402-015-2350-3. View