Return-to-Play Times and Player Performance After Medial Collateral Ligament Injury in Elite-Level European Soccer Players

Abstract

Background: Participation in elite-level soccer predisposes athletes to injuries of the medial collateral ligament (MCL), resulting in variable durations of time lost from sport. Purpose: To (1) determine the rate of return to play (RTP) and timing after MCL injuries, (2) investigate MCL reinjury incidence after RTP, and (3) evaluate the long-term effects of MCL injury on future performance. Study Design: Descriptive epidemiology study. Methods: Using publicly available records, we identified athletes who had sustained MCL injury between 2000 and 2016 across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A). Injured athletes were matched to controls using demographic characteristics and performance metrics from the season before injury. We recorded injury severity, RTP rate, reinjury incidence, player characteristics associated with RTP within 2 seasons of injury, player availability, field time, and performance metrics during the 4 seasons after injury. Results: A total of 59 athletes sustained 61 MCL injuries, with 86% (51/59) of injuries classified as moderate to severe and surgical intervention performed in 14% (8/59) of athletes. After injury, athletes missed a median of 33 days (range, 3-259 days) and 4 games (range, 1-30 games). Overall, 71% (42/59) of athletes returned successfully at the same level, with multivariable regression demonstrating no athlete characteristic predictive of RTP. MCL reinjury was reported in 3% (2/59) of athletes. Midfielders demonstrated decreased field time after RTP when compared with controls ( P < .05). No significant differences in player performance for any position were identified out to 4 seasons after injury. Injured athletes had a significantly higher rate of long-term retention ( P < .001). Conclusion: MCL injuries resulted in a median loss of 33 days in elite European soccer athletes, with the majority of injuries treated nonoperatively. RTP remained high, and few athletes experienced reinjury. While midfielders demonstrated a significant decrease in field time after RTP, player performance and long-term retention were not compromised. Future studies are warranted to better understand athlete-specific and external variables predictive of MCL injury and reinjury, while evaluating treatment and rehabilitation protocols to minimize time lost and to optimize athlete safety and health.

Revisiting Anterior Cruciate Ligament Repairs in an Athlete With Combined Grade III Medial Collateral Ligament and High-Grade Posterolateral Anterior Cruciate Ligament Tear: A Case Report

“…Some Grade III MCL injuries are treated nonoperatively although operative management is recommended in patients with severe multi-ligamentous injury, chronic instability, distal avulsion with a Stener-type entrapment of the torn end in the medial compartment, and nonoperative management failure [ 15 ]. Nonoperative treatment has been shown to increase return to playtime and reinjury and decrease field time after return to play in elite-level athletes [ 16 ] These findings have caused most sports medicine orthopedic surgeons to select operative management of Grade III MCL tears in athletes [ 5 ]. Acevedo et al were one of the first to demonstrate the success of operative management in Grade III MCL tears with an appropriate post-operative protocol in Division I football athletes [ 5 ].…”

The Anterior Fibers of the Superficial MCL and the ACL Restrain Anteromedial Rotatory Instability

“…24,30 Magnetic resonance imaging (MRI) studies have shown that concomitant medial injuries occur in as many of 67% of anterior cruciate ligament (ACL) injuries. 35 Nonoperative treatment of both low- and high-grade medial injuries before ACL reconstruction is commonplace, despite the presence of medial laxity at time zero, 5,21,26,35 and may result in good objective and patient-reported outcomes. Yet, a subset of patients have persistent medial laxity, 1,12,19 which may result in increased ACL graft strain and consequently increase the risk of ACL graft failure.…”