Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes

Abstract

Background: The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance. Purpose: To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position. Results: A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes ( P < .05), scored 0.09 more assists per game ( P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury ( P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games ( P < .05), 603 fewer total minutes ( P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury ( P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls. Conclusion: Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.

Distal fibula fractures in professional athletes: carbon plate fixation and accelerated rehabilitation protocol can improve return to play

“…Fractures of the distal fibula are particularly common, with an incidence of 100.8 per 100,000 people per year, accounting for an estimated 9% of all fractures 1 . In a recent epidemiological study of athletes who sustained a traumatic lower limb fracture between 2000 and 2016 in the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A), distal fibula fractures were shown to account for 36% of all lower limb fractures 2 . Although the incidence of this type of trauma in active athletes is not particularly high, the loss of about 77 ± 60 3 days from the specific sport affects the career of a high performance athlete.…”