U.S. Soccer reports knee injuries are one of the most common time-loss injuries that occur during games at all levels. Elite soccer players also are likely to injure their hamstrings, while soccer players at lower levels also are likely to sprain their ankles during games. Due to the severity of anterior cruciate ligament tears, knee injuries are a major concern to soccer's national organization.
Soccer
Because soccer is a fast-moving game that is played with the feet, demand is placed on the players' knees. In a short period, the ball covers a broad area of the field that is usually larger than a football field, 75 by 120 yards. Soccer rules are written to encourage continuous play during the two 45-minute periods, so players do not rest. International rules limit substitutions to three to seven per game, with players not allowed to return to the game. NCAA rules allow unlimited substitution, but players may not re-enter the game during the first period and a player who has been pulled from the game may return to play only once in the second half.
Overuse Knee Injuries
Given the rules of the game, it is not surprising that soccer players are susceptible to an overuse injury of the knee. Patellar tendonitis, or jumper's knee, is a common injury. The kneecap, or patella, is connected to the tibia by the patellar tendon. When the thigh muscles contract, the patellar tendon extends the knee. Running and kicking in soccer require repeated knee extension. In young soccer players, the patella tendon into the tibia can become inflamed. This is called Osgood-Schlatter syndrome. Treatment for overuse injuries is icing, rest and for some players, a patellar tendon strap.
Anterior Cruciate Ligament Tears
In soccer, anterior cruciate ligament tears usually are not the result of contact with another player. When a player with the foot planted and knee extended suddenly changes direction, an ACL tear can happen. This injury usually requires six to 12 months of rehabilitation after surgery. U.S. Soccer cites a 15-year study of NCAA soccer injuries showing 13 of 100,000 male and 31 per 100,000 female soccer players each season sustain an ACL injury. Few ACL reconstruction surgeries are performed in patients under age 14 years. Such surgeries surge among high school athletes, then decline slightly in college and decline further among adults.
Acute Knee Injuries
When an ACL tears, the medial collateral ligament, menisci or bone also may be injured. These injuries also occur in isolation. The MCL is injured when the knee is forced inward. This usually occurs when two players' legs become entangled. Rest and therapy is the initial MCL treatment. As pain resolves, a knee brace may be used. Meniscus tears occur with twisting injury from cutting or a collision and may require surgery. If the cartilage on the bone ends is injured, early arthritis may result, forcing players to stop playing soccer.
Prevention
Two FIFA centers of excellence, Santa Monica Orthopaedic and Sports Medicine and Oslo Sports Trauma Research Center, in conjunction with Cincinnati Children's Hospital Medical Center, reviewed causes of ACL tears and developed a program designed to reduce ACL injuries. The result was a 20-minute warm-up focusing on increasing players' core strength and ability to control knee motion during cutting and jump-landing. The resulting program of stretches, strengthening and agility was tested by high school and college soccer teams. Dr. Julie Gilchrist of the Centers for Disease Control found a 70 percent reduction in ACL injuries in teams that followed the program.
References
- U.S. Soccer; Prevent Common Injuries in Soccer: Knee Injuries
- FIFA; Laws of the Game; 2010
- 2010 and 2011 NCAA Men's and Women's Soccer Rules: Cliff McCrath ed.; 2010
- "American Journal of Sports Medicine": A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players; Julie Gilchrist, Bert R. Mandelbaum, Heidi Melancon, George W. Ryan, Holly J. Silvers, Letha Y. Griffin, MD, Diane S. Watanabe, Randall W. Dick, and Jiri Dvorak; 2008
- Mayo Clinic; Patellar tendinitis
