After ACL reconstruction, accelerated rehabilitation allows professional soccer players to return to official matches within 4-6 months of surgery, but in many cases accelerated rehabilitation is impossible. This retrospective study investigated the variables that affect the time to return to competition of professional soccer players after ACL reconstruction. Between October and December 2002, a questionnaire designed for this study was administered to the players competing in the Italian First Division (Series A) who previously reported an ACL reconstruction. Among 479 players surveyed, we identified 38 cases of arthroscopic ACL reconstruction (8%). The mean time to return to competition was 232±135 days from surgery (range, 76-791). In 12 cases (31.6%; group A), there was an isolated ACL rupture and these players returned to competition within 163±44 days after surgery (range, 76-231). Twenty cases were associated with one or more lesions (52.6%; group B), and these players returned to competition within 203±56 days after surgery (range, 146-329). Six cases reported complications after surgery or during rehabilitation (infections, swelling; 15.8%; group C) and returned to competition within 456±203 days after surgery (range, 233-791; p<0.001compared to groups A and B). In this study, a fast (<4 months) return to competition was achieved only in three cases of isolated ACL rupture (8%). Accelerated rehabilitation (<6 months) seems to be possible only in cases of isolated ACL reconstruction or when only the medial meniscus is involved as an associated lesion. The time to return to competition after ACL reconstruction was independent of the surgical technique used and must be considered the consequence of the complexity of the injury to the knee.

In the literature there are many studies on soccer injuries, but data regarding the epidemiology of anterior cruciate ligament (ACL) ruptures of professional players are scarce. The aim of this retrospective study was to investigate the prevalence and the incidence of ACL surgical reconstructions of top-level professional soccer players. A questionnaire was administered by the sports physicians of the 18 teams competing in the 2002-2003 Italian Serie A Championship to players who reported in their career one or more ACL reconstructions. The prevalence of ACL reconstructions was 10.4%; the incidence was 1.08 every 1000 competitive playing exposures or 0.72 every 1000 h of game. Players who reported an ACL reconstruction when younger (20.3±2.1 years) had a higher risk of ACL injury to the other side. Contact injuries were more frequent during official games, while during training or nonofficial games non-contact injuries were more frequent. These data should be considered by team physicians and coaches to prevent ACL injuries and re-injuries in professional soccer.

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