Guest authored by:
Shane K. Woolf, M.D.
Associate Professor of Orthopaedics and Chief of Sports Medicine
MUSC Health

Anterior Cruciate Ligament Injuries in Soccer Players

For the next four weeks, the world’s attention will turn to Brazil, as nations from around the globe compete in soccer’s greatest event- The World Cup.  Soccer continues to grow in popularity and is a sport shared around the globe. Indeed, according to FIFA over 265 million men and women participate in soccer worldwide.  As one might imagine, with such a high number of participants there is also a potentially high number of injuries involving bones, joints, and ligaments. One injury among the most common in sports such as soccer is a tear of the anterior cruciate ligament (ACL). This small strip of collagen connective tissue in the center of the knee helps to stabilize the leg bone (or tibia) with the thigh bone (or femur). Recent understanding of the function of the anterior cruciate ligament tells us that it is important for stability of the knee from front to back as well as controlling rotation of the joint.

Around 300,000 ACL injuries occur annually. Sports such as soccer, which involve deceleration, turning, cutting, twisting, pivoting and jumping can place the ACL at risk for injury because of the nature of the stresses applied to the ligament. In addition, direct contact, as occurs during a slide tackle or fighting for the ball can also place stress on the knee joint. While both male and female athletes are at risk for ACL injury, female soccer players are known to experience a much higher rate of injury. In some studies female soccer players are up to 3 times more likely than their male counterparts to suffer ACL tears. In fact, a many as 5 out of 100 year round female soccer players are at risk for tearing the ACL. This gender variation is thought to be related to anatomic differences, knee alignment, hormonal profiles, strength and sporting technique.

In general, when ACL injuries occur, an athlete’s ability to participate in sports like soccer is compromised because of knee instability. This limits the athlete’s ability to fully stress the leg and perform at a high level. Pain is common, but also lack of confidence in the knee and actual instability are significant and limiting issues. Physiotherapy and rehabilitation of the knee can be helpful but may not eliminate the sensation of an unsteady joint. Often, surgical reconstruction of the damaged ligament is performed to restore stability and function. Recovery and return to play are possible when the surgery is successful, but demands lengthy rehabilitation, dedicated therapy protocols, and patience. Most athletes are unable to return to the soccer pitch for at least 6-9 months after surgery.

 Variations in our physical anatomy and gender-based differences are obviously not within the control of the athlete. So what can be done to reduce the chances of injury altogether? How can the competitive soccer player maintain a healthy knee that performs well throughout a lifetime of competition? While nothing can eliminate injury risk, there are several measures that the athlete can take to at least lessen the chance of experiencing an ACL tear. These include:

  • Proper conditioning, including strength training of the quadriceps and hamstrings as well as cardiovascular endurance
  • Proper cleats and boots/footwear
  • Practice and application of proper technique in jumping, sliding tackling, and tracking the ball
  • Neuromuscular education programs designed to optimize the function of muscles around the knees. Such programs are available through a physiotherapist like those in the MUSC Sports Medicine Program and can be performed in the off-season as a dedicated conditioning program. Up to 50% of ACL tears can be prevented from a specialized neuromuscular training program.

Whether a recreational or elite level athlete, the ultimate goal is to remain active and to enjoy the sport you love! These tips can help keep you on the pitch for years to come. If your knee suffers an injury, though, make certain to see an orthopaedist for an assessment. For now, enjoy the fantastic World Cup soccer, and get inspired to go out and play next chance you get!