Association of Skeletal Maturity and Injury Risk in Elite Youth Soccer Players: A 4-Season Prospective Study With Survival Analysis

Abstract

Background: The association between injury risk and skeletal maturity in youth soccer has received little attention. Purpose: To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall and to the lower limb apophysis. Study Design: Descriptive epidemiology study. Methods: All injuries that required medical attention and led to time loss were recorded prospectively during 4 consecutive seasons in 283 unique soccer players from U-13 (12 years of age) to U-19 (18 years). The skeletal age (SA) was assessed in 454 player-seasons using the Fels method, and skeletal maturity status (SA minus chronological age) was classified as follows: late, SA >1 year behind chronological age; normal, SA ±1 year of chronological age; early, SA >1 year ahead of chronological age; and mature, SA = 18 years. An adjusted Cox regression model was used to analyze the injury risk. Results: A total of 1565 injuries were recorded; 60% were time-loss injuries, resulting in 17,772 days lost. Adjusted injury-free survival analysis showed a significantly greater hazard ratio (HR) for different status of skeletal maturity: early vs normal (HR = 1.26 [95% CI, 1.11-1.42]; P < .001) and early vs mature (HR = 1.35 [95% CI, 1.17-1.56]; P < .001). Players who were skeletally mature at the wrist had a substantially decreased risk of lower extremity apophyseal injuries (by 45%-61%) compared with late ( P < .05), normal ( P < .05), and early ( P < .001) maturers. Conclusion: Musculoskeletal injury patterns and injury risks varied depending on the players’ skeletal maturity status. Early maturers had the greatest overall adjusted injury risk. Players who were already skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries but were still vulnerable for hip and pelvis apophyseal injuries.

Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4‐season prospective study

“…For complementary broader injury epidemiological information, please refer to published studies. 18,20 Player unavailability was calculated as the number of days (severity) missed from the date of injury (day zero) until the day before the return to training participation and game availability.…”

“…The incidence distribution of the apophyseal injuries locations by age-groups reflects the maturation process as discussed earlier and may highlight fragile period of endochondral ossification of the corresponding apophysis more vulnerable. Recently, Materne et al 20 emphasized that while players who were skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries, they were still vulnerable for hip and pelvic apophyseal injuries. This emphasizes the need for clinical consideration of the sequential maturation process of the lower limb (distal to proximal).…”

Predictive Analytic Techniques to Identify Hidden Relationships between Training Load, Fatigue and Muscle Strains in Young Soccer Players

“…The more mature players are able to maximize the use of anaerobic system [ 56 ] and consequently express more power, speed and strength. Moreover, they are characterized by a greater body mass that could increase the risk of lower limb muscle strains [ 57 ]. Indeed, more mature players owing to their body size, produce a greater match running performance compared to their less mature teammates [ 57 ].…”

“…Moreover, they are characterized by a greater body mass that could increase the risk of lower limb muscle strains [ 57 ]. Indeed, more mature players owing to their body size, produce a greater match running performance compared to their less mature teammates [ 57 ]. All these factors could increase susceptibility to MSI in more mature players being involved in a more demanding context.…”

The most common injuries, rehabilitation and recovery among soccer practitioners

“…In the conducted study, information was obtained about the cause of the injury and the moment in which it occurred. The most common cause of injury was the participation of third parties (63.3%) [18], and the most common injury occurred during a match (65.3%) [5,21,23,24].…”