Acl Tears in Female and Male Professional Soccer Players

Acl Tears in Female and Male Professional Soccer Players | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acl Tears in Female and Male Professional Soccer Players Daniele Mazza, Alessandro Carrozzo, Alessandro Annibaldi, Francesco De Carli, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5469754/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : Women’s football has experienced significant growth, with approximately 29 million female players worldwide, emphasizing the need for research focused on injuries. Anterior cruciate ligament (ACL) ruptures are a major concern, particularly among elite players, and understanding gender differences in injury incidence and recovery is crucial for developing effective prevention and rehabilitation strategies. Methods : This retrospective study analyzed ACL injuries in male and female players from the top five European leagues (Serie A, Premier League, Ligue 1, La Liga, and Bundesliga) during the 2022-2023. A total of 169 players (71 female, 101 male) who underwent ACL reconstruction were included. Data on age, body mass index (BMI), injury history, affected side, playing position, and return-to-play (RTP) outcomes were collected. Statistical analyses were performed using SPSS® software with a significance level of P < .05. Results : Female players had a significantly longer average RTP (300 days) compared to male players (248 days) (P < .001). Furthermore, 3.5% of female athletes did not return to play, while 12.2% of male athletes failed to achieve RTP (P = .028). The defender position had the highest non-return rate (25%). Conclusion : This study highlights significant gender differences in ACL injury recovery in professional football. Female athletes face longer rehabilitation periods and greater challenges in returning to play, indicating a need for tailored injury management strategies and position-specific rehabilitation programs. Further research and targeted interventions are essential to improve outcomes for female players, enhancing safety and career longevity. ACL RTP soccer female players INTRODUCTION Women’s football is becoming more popular than ever, with around 29 million female soccer players in the world, which represents 10% of the total participants. This surge in participation highlights a growing interest and investment in women's sports, reflecting broader societal changes toward gender equality in athletics. As more women engage in soccer at both amateur and professional levels, the visibility and competitiveness of women's football continue to rise, attracting larger audiences and increased media coverage ( 1 ). Practicing soccer not only offers numerous physical benefits, including improved cardiovascular health ( 2 ), muscle strength ( 3 ), and coordination ( 4 ), but also fosters teamwork, discipline, and resilience ( 5 ). However, despite these advantages, the sport poses certain risks, particularly concerning injuries. Studies ( 6 – 7 ) indicate that injuries are frequent among female soccer players, with elite players of any age showing a notably high incidence of such occurrences. This trend emphasizes the need for enhanced training methods, injury prevention strategies, and proper medical support systems to safeguard players' health. Among soccer-related injuries, anterior cruciate ligament (ACL) ruptures are particularly concerning due to their severity and impact on a player’s career. Few studies ( 8 – 9 ) have thoroughly compared ACL ruptures between female and male professional soccer players, often attributing differences to anatomical, hormonal, and biomechanical factors. Understanding these disparities is crucial for developing targeted interventions that could minimize risk and support gender-specific rehabilitation protocols. The present study aims to evaluate and descriptively report ACL ruptures in both women and men professional soccer players, with return to play (RTP) as the primary outcome. By assessing RTP time frames and success rates, the study seeks to provide comprehensive insights into recovery processes and identify potential areas for improvement in medical and training practices. Additionally, the research examines contralateral ACL injuries, surgical failures, and postoperative complications, offering a holistic view of the challenges faced by athletes undergoing ACL repair. The hypothesis of the study is that professional female soccer players are at a higher risk of anterior cruciate ligament (ACL) tears and are more prone to potential complications. METHODS In this retrospective study, the authors identified female and male soccer players who sustained an ACL injury in the top-five European Soccer Leagues, according to the UEFA Country Ranking, during the years 2022 and 2023. The leagues investigated included Serie A (Italy), Premier League (England), Ligue 1 (France), LaLiga (Spain), and Bundesliga (Germany). These leagues were selected due to their prominence and competitive level, offering a comprehensive view of ACL injuries across elite soccer in Europe. All included professional soccer players were members of the first team of their respective clubs at the time of injury and were required to have a minimum follow-up period of one year. This follow-up was crucial for accurately assessing recovery outcomes and understanding the long-term implications of ACL injuries. The study focused on various parameters, including age, body mass index (BMI), injury history, the affected side of the body, playing position (goalkeeper, defender, midfielder, or forward), and return-to-play (RTP) data. Data was retrieved from the publicly available media-based platform Transfermarkt ( www.Transfermarkt.com , GmbH & Co. KG, Hamburg, Germany), which provides comprehensive statistics and information on players and clubs. In instances where data was missing, further investigation was conducted through other publicly available online sources such as official team websites, press releases, and sports news outlets to ensure a thorough and accurate dataset. Return to play was assessed as the number of days from the knee surgery to the first match appearance with the first team, reserve team, youth team, or national team. This metric is critical for evaluating the effectiveness of rehabilitation protocols and understanding the impact of ACL injuries on athletic careers. The study defined primary ACL injury as a first-time rupture of the ligament, while revision ACL surgery was classified as a second-time reconstruction. Complications were defined as events such as re-ruptures, patella fractures, reoperations, or any adverse event occurring within eight months post-ACL reconstruction (ACLR) that resulted in a delayed or missed RTP. By analyzing these complications, the study aims to shed light on the broader implications of ACL injuries and their management, providing valuable insights for healthcare professionals and sports organizations focused on optimizing athlete care and minimizing injury recurrence. Ultimately, the findings from this research could contribute to better preventative strategies and rehabilitation practices in the world of professional soccer, enhancing player safety and career longevity. Statistical Analysis Analyses were performed with SPSS® Statistics software (version 28.0.1.1; IBM SPSS, Chicago, IL). A significance level of P < .05 was used. Descriptive analyses were performed on the entire cohort based on the specific characteristics of the data. The normality of distributions was assessed using the Kolmogorov-Smirnov test. For quantitative variables, analyses included the number of observed and missing values, mean, standard deviation (SD), median, and range (minimum and maximum values). For qualitative variables, analyses included the number of observed and missing values and the frequency and percentage of cases within each category. Differences in categorical data between groups were assessed using the chi-squared or Fisher's exact test, while the Mann-Whitney or Student's t-test was used for quantitative variables. RESULTS During the study period, 170 professional soccer players underwent ACL reconstruction. Exclusion of one player due to retirement and a second ACL surgery in three other players resulted in a final cohort of 169 players who underwent 172 ACL reconstructions. This cohort consisted of 71 female and 101 male athletes. The mean follow-up was 555.5 ± 199.7 days with a mean age of 25.9 ± 4.1 years. Significant differences in both follow-up duration and age were observed between male and female players, as detailed in Table 1 , which presents the demographic data of the patients. Although the distribution by playing position did not show significant differences between genders, defenders constituted the majority in both groups. Table 1 Demographic Information of Included Patients. The data are presented either as mean ± standard deviation (mean ± SD) or as number and percentage (n %). Female (n = 71) Male (n = 101) P value Age, mean ± SD (range), years 24.6 ± 3.9 (16–33) 26.8 ± 4.1 (19–40) < .001 Follow-up, mean ± SD (range), years 646 ± 164 (273–900) 491.9 ± 198.7 (176–871) < .001 Side, n (%) .87 Left 30 (40.5) 44 (59.5) Right 41 (41.8) 57 (58.2) Role, n (%) Goalkeeper 5 ( 7 ) 7 (6.9) .3 Defender 23 (32.4) 41 (40.6) Midfielder 20 (28.2) 33 (32.7) Forward 23 (32.4) 20 (19.8) Table 2 Return to Play Rates Categorized by Player Role. Data are represented as number and percentage. RTP, return to play. Did not achieved RTP Achieved RTP Goalkeeper, n (%) 0 12 (100) Defender, n (%) 16 (25) 48 (75) Midfielder, n (%) 6 (11.3) 47 (88.7) Forward, n (%) 5 (11.6) 38 (88.4) Of the female athletes, 6 (3.5%) did not return to play compared to 21 (12.2%) of the male athletes, a statistically significant difference (P = .028). The most affected position was defender: out of 64 players, 16 (25%) did not return to play, representing 59.5% of athletes who did not return to play. The overall average time to return to play (RTP) for the cohort was 271 days ± 78.1. For female athletes, the average RTP was 300 days ± 69.4, ranging from 148 to 461 days. Conversely, male athletes experienced a significantly shorter RTP, averaging 247.8 days ± 77.4, with a range from 93 to 575 days (P < .001). There were no significant differences between the two groups in terms of both ipsilateral (P = .69) and contralateral (P = .29) ACL injuries. Postoperative outcomes are displayed in Table 3 . Table 3 Postoperative Outcome of Players Who Returned to Play. The data are presented either as mean ± standard deviation (mean ± SD) or as number and percentage (n %). Female (n = 71) Male (n = 101) P value Return to Play, mean ± SD (range), days 300 days ± 69.4 (148–461) 247.8 ± 77.4 (93–575) < .001 Ipsilateral rupture, n (%) 2 (1.2) 4 (2.3) .69 Contralateral rupture, n (%) 5 (2.9) 12 ( 7 ) .29 DISCUSSION The results of this retrospective study add to the growing body of evidence regarding anterior cruciate ligament injuries in professional soccer players, with a particular focus on gender differences. With women’s football experiencing unprecedented growth—boasting approximately 29 million female players worldwide—the need for tailored injury prevention and management strategies has never been more critical. The study aimed to analyze ACL injuries among both male and female professional players in the top-five European soccer leagues and found significant differences in return to play (rates and duration following surgery, which warrants further exploration. The findings of the study indicate that female athletes are indeed at a higher risk of complications following ACL injuries, as evidenced by the lower RTP rates. Specifically, only 3.5% of female athletes and 12.2% of male athletes did not achieve RTP, with defenders suffering the most significant impact. This highlights a crucial gap in the recovery outcomes between genders, suggesting that female players may face unique challenges during their rehabilitation. The longer average RTP duration for female players (300 days) compared to male players (247.8 days) signifies that there may be additional factors influencing recovery in female athletes, such as different physiologies and possibly less frequent access to high-quality rehabilitation resources. The study found no significant differences in the rates of ipsilateral and contralateral ACL injuries between genders. However, the percentage of contralateral ruptures observed in males (7%) was notably higher than in females (2.9%), which could point towards differences in physical stressors or recovery practices. This observation emphasizes the need for focused injury surveillance and preventive measures, especially for male players, to mitigate the risk of subsequent knee injuries. Fältström et al. ( 9 ) found that male football players reported more favorable results than females in patient-reported knee function, satisfaction with activity level and knee function, knee-related quality of life and psychological readiness to return to sport 1–3 years after ACL reconstruction. The results contribute to a better understanding of the eventual effect of patient sex on outcomes after ACL reconstruction in football players. While the study sheds light on the recovery trajectories of ACL injuries, several factors warrant further discussion. One critical element is the role of playing positions. The predominance of defenders in both genders indicates that the demands of this role might predispose players to higher injury risks. This finding underscores the importance of position-specific training and conditioning regimens that can better prepare players for the physical demands of their roles on the field. Future research could focus on developing tailored prevention strategies specific to each position to reduce injury incidence and enhance overall player safety. Magaña-Ramírez et al. ( 10 ) supported the use of FIFA 11 + and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Moreover, the variance in follow-up durations between male and female players raises questions about the influence of support structures and rehabilitation protocols available to each gender. As women’s soccer continues to grow commercially and athletically, it is essential for teams to ensure equitable access to medical care, training resources, and rehabilitation services. Implementing gender-specific approaches in injury management and incorporating sports science research into practice could help bridge the disparity in recovery outcomes. den Hollander et al. ( 11 ) emphasized the need for careful consideration in scheduling fixtures for elite women's football, particularly regarding the number of matches played in a short time frame. The study advocates for strategies to enhance rest and recovery, aiming to mitigate injury risks and ensure player safety. The study's conclusions hold significant implications for coaching staff and medical teams. The need for tailored training regimens that address the unique anatomical and physiological characteristics of female athletes is paramount. Coaches and healthcare professionals should collaborate to create comprehensive injury prevention programs integrating strength, flexibility, and neuromuscular training. These programs should be routinely evaluated and modified based on emerging evidence, ensuring both male and female players receive optimal care before and after injuries. As the data for this study were obtained from public online sources, there were several limitations inherent to this approach. Recent literature ( 12 ) has indicated that such online platforms may underreport the actual incidence of injuries among athletes. It is therefore possible that this study overlooked some injured players. Additionally, due to the lack of accessible medical records or imaging, information regarding associated injuries—such as concomitant meniscus tears, collateral ligament damage, and articular cartilage injuries—along with details about surgical techniques, graft selection, and rehabilitation programs, were unavailable. These factors could significantly influence players' recovery and performance following an ACL injury, and analyzing data that includes these variables would be beneficial. However, since a comprehensive injury database akin to those utilized in the NFL or NBA does not exist for European soccer, the sources we used represent the best available and independent option, having been effectively employed in similar research previously. CONCLUSION The findings of this study indicate an association between gender and time needed to RTP after an ACL injury, however, no relationship between gender and subsequent ipsilateral or contralateral rupture were identified, nor the likelihood of returning to play or having a history of contralateral or ipsilateral ACL ruptures. Declarations Author Contribution DM And FdC wrote the main paper, VS And AA retrieved all data, AC performed statistical analysis, PZ and AdC reviewed the manuscripts. Human Ethics and Consent to Participate declarations: not applicable. No Funding was used for the manuscript. References Martín-San Agustín R, Medina-Mirapeix F, Esteban-Catalán A, Escriche-Escuder A, Sánchez-Barbadora M, Benítez-Martínez JC (2021) Epidemiology of Injuries in First Division Spanish Women's Soccer Players. Int J Environ Res Public Health 18(6):3009. 10.3390/ijerph18063009 PMID: 33804081; PMCID: PMC8000692 Tenforde AS, Fredericson M (2011) Influence of Sports Participation on Bone Health in the Young Athlete: A Review of the Literature. Pm R 3:861–867 Helge EW, Aagaard P, Jakobsen MD et al (2010) Recreational football training decreases risk factors for bone fractures in untrained premenopausal women. Scand J Med Sci Sports 20(S1):31–39 Seabra A, Marques E, Brito J et al (2012) Muscle strength and soccer practice as major determinants of bone mineral density in adolescents. Joint Bone Spine 79(4):403–408 Snyder AR, Martinez JC, Bay RC, Parsons JT, Sauers EL, Valovich McLeod TC (2010) Health-related quality of life differs between adolescent athletes and adolescent nonathletes. J Sport Rehabil 19(3):237–248 Le Gall F, Carling C, Reilly T (2008) Injuries in Young Elite Female Soccer Players: An 8-Season Prospective Study. Am J Sports Med 36:276–284 Clausen MB, Zebis MK, Møller M, Krustrup P, Hölmich P, Wedderkopp N, Andersen LL, Christensen KB, Thorborg K (2014) High Injury Incidence in Adolescent Female Soccer. Am J Sports Med 42:2487–2494 Childers J, Eng E, Lack B, Lin S, Knapik DM, Kaplan DJ, Jackson GR, Chahla J Reported Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes Is Greatest in Female Soccer Players and Athletes Participating in Club Sports: A Systematic Review and Meta-analysis. Arthroscopy. 2024 Apr 29:S0749-8063(24)00298-6. doi: 10.1016/j.arthro.2024.03.050. Epub ahead of print. PMID: 38692337 Fältström A, Hägglund M, Kvist J (2024) Male football players have better patient-reported outcomes after primary anterior cruciate ligament reconstruction compared with females. BMC Sports Sci Med Rehabil 16(1):199. 10.1186/s13102-024-00996-1 PMID: 39322969; PMCID: PMC11426077.ù Magaña-Ramírez M, Gallardo-Gómez D, Álvarez-Barbosa F, Corral-Pernía JA (2024) What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? A systematic review and network meta-analysis. J Sci Med Sport 27(4):234–242 den Hollander S, Culvin A, Kerkhoffs G, Gouttebarge V (2024) Match workload and international travel associated with (ACL) injuries in professional women's football. Eur J Sport Sci 24(10):1423–1431 Inclan PM, Chang PS, Mack CD et al Validity of research based on public data in sports medicine: a quantitative assessment of anterior cruciate ligament injuries in the National Football League [published online June 214, 2021]. Am J Sports Med. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5469754","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":382197136,"identity":"0a454bbf-a866-46c7-be4c-599beaf9be13","order_by":0,"name":"Daniele Mazza","email":"","orcid":"","institution":"Istituto Dermopatico dell'Immacolata","correspondingAuthor":false,"prefix":"","firstName":"Daniele","middleName":"","lastName":"Mazza","suffix":""},{"id":382197138,"identity":"b91d959d-6902-4ce7-a864-3d168823a722","order_by":1,"name":"Alessandro Carrozzo","email":"","orcid":"","institution":"Istituto di Medicina e Scienza dello Sport CONI - Italian Olympic Committee","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Carrozzo","suffix":""},{"id":382197139,"identity":"6185b786-97f9-4eeb-ab06-4d21247c3abf","order_by":2,"name":"Alessandro Annibaldi","email":"","orcid":"","institution":"Istituto di Medicina e Scienza dello Sport CONI - Italian Olympic Committee","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Annibaldi","suffix":""},{"id":382197140,"identity":"d86ec73b-7eb4-444a-9fed-2d181ca3a433","order_by":3,"name":"Francesco De Carli","email":"data:image/png;base64,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","orcid":"","institution":"Orthopaedic Unit and Kirk Kilgour Sports Injury Center, S. Andrea Hospital, University of Rome \"Sapienza\"","correspondingAuthor":true,"prefix":"","firstName":"Francesco","middleName":"","lastName":"De Carli","suffix":""},{"id":382197141,"identity":"83fc31c3-5d08-4f84-8b42-a963eea3e9e3","order_by":4,"name":"Vincenzo Santoriello","email":"","orcid":"","institution":"Catholic University of the Sacred Heart","correspondingAuthor":false,"prefix":"","firstName":"Vincenzo","middleName":"","lastName":"Santoriello","suffix":""},{"id":382197142,"identity":"0415e0e7-8361-4d6d-8f4f-f7850ee37415","order_by":5,"name":"Paolo Zeppilli","email":"","orcid":"","institution":"Italian Football Association","correspondingAuthor":false,"prefix":"","firstName":"Paolo","middleName":"","lastName":"Zeppilli","suffix":""},{"id":382197143,"identity":"e8a3d822-9fae-424e-803e-55e167563f58","order_by":6,"name":"Angelo De Carli","email":"","orcid":"","institution":"Orthopaedic Unit and Kirk Kilgour Sports Injury Center, S. Andrea Hospital, University of Rome \"Sapienza\"","correspondingAuthor":false,"prefix":"","firstName":"Angelo","middleName":"","lastName":"De Carli","suffix":""}],"badges":[],"createdAt":"2024-11-17 12:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5469754/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5469754/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73177909,"identity":"6c915fb3-280e-4e4a-8308-d984c61836c1","added_by":"auto","created_at":"2025-01-07 12:24:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":293079,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5469754/v1/87503820-73ef-4017-9a39-e0c0cecacb94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAcl Tears in Female and Male Professional Soccer Players\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWomen\u0026rsquo;s football is becoming more popular than ever, with around 29\u0026nbsp;million female soccer players in the world, which represents 10% of the total participants. This surge in participation highlights a growing interest and investment in women's sports, reflecting broader societal changes toward gender equality in athletics. As more women engage in soccer at both amateur and professional levels, the visibility and competitiveness of women's football continue to rise, attracting larger audiences and increased media coverage (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePracticing soccer not only offers numerous physical benefits, including improved cardiovascular health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), muscle strength (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and coordination (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), but also fosters teamwork, discipline, and resilience (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, despite these advantages, the sport poses certain risks, particularly concerning injuries. Studies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) indicate that injuries are frequent among female soccer players, with elite players of any age showing a notably high incidence of such occurrences. This trend emphasizes the need for enhanced training methods, injury prevention strategies, and proper medical support systems to safeguard players' health.\u003c/p\u003e \u003cp\u003eAmong soccer-related injuries, anterior cruciate ligament (ACL) ruptures are particularly concerning due to their severity and impact on a player\u0026rsquo;s career. Few studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) have thoroughly compared ACL ruptures between female and male professional soccer players, often attributing differences to anatomical, hormonal, and biomechanical factors. Understanding these disparities is crucial for developing targeted interventions that could minimize risk and support gender-specific rehabilitation protocols.\u003c/p\u003e \u003cp\u003eThe present study aims to evaluate and descriptively report ACL ruptures in both women and men professional soccer players, with return to play (RTP) as the primary outcome. By assessing RTP time frames and success rates, the study seeks to provide comprehensive insights into recovery processes and identify potential areas for improvement in medical and training practices. Additionally, the research examines contralateral ACL injuries, surgical failures, and postoperative complications, offering a holistic view of the challenges faced by athletes undergoing ACL repair.\u003c/p\u003e \u003cp\u003eThe hypothesis of the study is that professional female soccer players are at a higher risk of anterior cruciate ligament (ACL) tears and are more prone to potential complications.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eIn this retrospective study, the authors identified female and male soccer players who sustained an ACL injury in the top-five European Soccer Leagues, according to the UEFA Country Ranking, during the years 2022 and 2023. The leagues investigated included Serie A (Italy), Premier League (England), Ligue 1 (France), LaLiga (Spain), and Bundesliga (Germany). These leagues were selected due to their prominence and competitive level, offering a comprehensive view of ACL injuries across elite soccer in Europe.\u003c/p\u003e \u003cp\u003eAll included professional soccer players were members of the first team of their respective clubs at the time of injury and were required to have a minimum follow-up period of one year. This follow-up was crucial for accurately assessing recovery outcomes and understanding the long-term implications of ACL injuries. The study focused on various parameters, including age, body mass index (BMI), injury history, the affected side of the body, playing position (goalkeeper, defender, midfielder, or forward), and return-to-play (RTP) data.\u003c/p\u003e \u003cp\u003eData was retrieved from the publicly available media-based platform Transfermarkt (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.Transfermarkt.com\" target=\"_blank\"\u003ewww.Transfermarkt.com\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.Transfermarkt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, GmbH \u0026amp; Co. KG, Hamburg, Germany), which provides comprehensive statistics and information on players and clubs. In instances where data was missing, further investigation was conducted through other publicly available online sources such as official team websites, press releases, and sports news outlets to ensure a thorough and accurate dataset.\u003c/p\u003e \u003cp\u003eReturn to play was assessed as the number of days from the knee surgery to the first match appearance with the first team, reserve team, youth team, or national team. This metric is critical for evaluating the effectiveness of rehabilitation protocols and understanding the impact of ACL injuries on athletic careers. The study defined primary ACL injury as a first-time rupture of the ligament, while revision ACL surgery was classified as a second-time reconstruction.\u003c/p\u003e \u003cp\u003eComplications were defined as events such as re-ruptures, patella fractures, reoperations, or any adverse event occurring within eight months post-ACL reconstruction (ACLR) that resulted in a delayed or missed RTP. By analyzing these complications, the study aims to shed light on the broader implications of ACL injuries and their management, providing valuable insights for healthcare professionals and sports organizations focused on optimizing athlete care and minimizing injury recurrence. Ultimately, the findings from this research could contribute to better preventative strategies and rehabilitation practices in the world of professional soccer, enhancing player safety and career longevity.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAnalyses were performed with SPSS\u0026reg; Statistics software (version 28.0.1.1; IBM SPSS, Chicago, IL). A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;.05 was used. Descriptive analyses were performed on the entire cohort based on the specific characteristics of the data. The normality of distributions was assessed using the Kolmogorov-Smirnov test. For quantitative variables, analyses included the number of observed and missing values, mean, standard deviation (SD), median, and range (minimum and maximum values). For qualitative variables, analyses included the number of observed and missing values and the frequency and percentage of cases within each category. Differences in categorical data between groups were assessed using the chi-squared or Fisher's exact test, while the Mann-Whitney or Student's t-test was used for quantitative variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study period, 170 professional soccer players underwent ACL reconstruction. Exclusion of one player due to retirement and a second ACL surgery in three other players resulted in a final cohort of 169 players who underwent 172 ACL reconstructions. This cohort consisted of 71 female and 101 male athletes. The mean follow-up was 555.5\u0026thinsp;\u0026plusmn;\u0026thinsp;199.7 days with a mean age of 25.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 years. Significant differences in both follow-up duration and age were observed between male and female players, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which presents the demographic data of the patients. Although the distribution by playing position did not show significant differences between genders, defenders constituted the majority in both groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Information of Included Patients. The data are presented either as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) or as number and percentage (n %).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (range), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 (16\u0026ndash;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 (19\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (range), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e646\u0026thinsp;\u0026plusmn;\u0026thinsp;164 (273\u0026ndash;900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e491.9\u0026thinsp;\u0026plusmn;\u0026thinsp;198.7 (176\u0026ndash;871)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoalkeeper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidfielder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReturn to Play Rates Categorized by Player Role. Data are represented as number and percentage. RTP, return to play.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDid not achieved RTP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAchieved RTP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoalkeeper, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidfielder, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (88.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForward, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (88.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the female athletes, 6 (3.5%) did not return to play compared to 21 (12.2%) of the male athletes, a statistically significant difference (P\u0026thinsp;=\u0026thinsp;.028). The most affected position was defender: out of 64 players, 16 (25%) did not return to play, representing 59.5% of athletes who did not return to play.\u003c/p\u003e \u003cp\u003eThe overall average time to return to play (RTP) for the cohort was 271 days\u0026thinsp;\u0026plusmn;\u0026thinsp;78.1. For female athletes, the average RTP was 300 days\u0026thinsp;\u0026plusmn;\u0026thinsp;69.4, ranging from 148 to 461 days. Conversely, male athletes experienced a significantly shorter RTP, averaging 247.8 days\u0026thinsp;\u0026plusmn;\u0026thinsp;77.4, with a range from 93 to 575 days (P\u0026thinsp;\u0026lt;\u0026thinsp;.001). There were no significant differences between the two groups in terms of both ipsilateral (P\u0026thinsp;=\u0026thinsp;.69) and contralateral (P\u0026thinsp;=\u0026thinsp;.29) ACL injuries.\u003c/p\u003e \u003cp\u003ePostoperative outcomes are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative Outcome of Players Who Returned to Play. The data are presented either as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) or as number and percentage (n %).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReturn to Play, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (range), days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 days\u0026thinsp;\u0026plusmn;\u0026thinsp;69.4 (148\u0026ndash;461)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247.8\u0026thinsp;\u0026plusmn;\u0026thinsp;77.4 (93\u0026ndash;575)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIpsilateral rupture, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContralateral rupture, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results of this retrospective study add to the growing body of evidence regarding anterior cruciate ligament injuries in professional soccer players, with a particular focus on gender differences. With women\u0026rsquo;s football experiencing unprecedented growth\u0026mdash;boasting approximately 29\u0026nbsp;million female players worldwide\u0026mdash;the need for tailored injury prevention and management strategies has never been more critical. The study aimed to analyze ACL injuries among both male and female professional players in the top-five European soccer leagues and found significant differences in return to play (rates and duration following surgery, which warrants further exploration.\u003c/p\u003e \u003cp\u003eThe findings of the study indicate that female athletes are indeed at a higher risk of complications following ACL injuries, as evidenced by the lower RTP rates. Specifically, only 3.5% of female athletes and 12.2% of male athletes did not achieve RTP, with defenders suffering the most significant impact. This highlights a crucial gap in the recovery outcomes between genders, suggesting that female players may face unique challenges during their rehabilitation. The longer average RTP duration for female players (300 days) compared to male players (247.8 days) signifies that there may be additional factors influencing recovery in female athletes, such as different physiologies and possibly less frequent access to high-quality rehabilitation resources.\u003c/p\u003e \u003cp\u003eThe study found no significant differences in the rates of ipsilateral and contralateral ACL injuries between genders. However, the percentage of contralateral ruptures observed in males (7%) was notably higher than in females (2.9%), which could point towards differences in physical stressors or recovery practices. This observation emphasizes the need for focused injury surveillance and preventive measures, especially for male players, to mitigate the risk of subsequent knee injuries.\u003c/p\u003e \u003cp\u003eF\u0026auml;ltstr\u0026ouml;m et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) found that male football players reported more favorable results than females in patient-reported knee function, satisfaction with activity level and knee function, knee-related quality of life and psychological readiness to return to sport 1\u0026ndash;3 years after ACL reconstruction. The results contribute to a better understanding of the eventual effect of patient sex on outcomes after ACL reconstruction in football players.\u003c/p\u003e \u003cp\u003eWhile the study sheds light on the recovery trajectories of ACL injuries, several factors warrant further discussion. One critical element is the role of playing positions. The predominance of defenders in both genders indicates that the demands of this role might predispose players to higher injury risks. This finding underscores the importance of position-specific training and conditioning regimens that can better prepare players for the physical demands of their roles on the field. Future research could focus on developing tailored prevention strategies specific to each position to reduce injury incidence and enhance overall player safety.\u003c/p\u003e \u003cp\u003eMaga\u0026ntilde;a-Ram\u0026iacute;rez et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) supported the use of FIFA 11\u0026thinsp;+\u0026thinsp;and Kn\u0026auml;kontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females.\u003c/p\u003e \u003cp\u003eMoreover, the variance in follow-up durations between male and female players raises questions about the influence of support structures and rehabilitation protocols available to each gender. As women\u0026rsquo;s soccer continues to grow commercially and athletically, it is essential for teams to ensure equitable access to medical care, training resources, and rehabilitation services. Implementing gender-specific approaches in injury management and incorporating sports science research into practice could help bridge the disparity in recovery outcomes.\u003c/p\u003e \u003cp\u003eden Hollander et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) emphasized the need for careful consideration in scheduling fixtures for elite women's football, particularly regarding the number of matches played in a short time frame. The study advocates for strategies to enhance rest and recovery, aiming to mitigate injury risks and ensure player safety.\u003c/p\u003e \u003cp\u003eThe study's conclusions hold significant implications for coaching staff and medical teams. The need for tailored training regimens that address the unique anatomical and physiological characteristics of female athletes is paramount. Coaches and healthcare professionals should collaborate to create comprehensive injury prevention programs integrating strength, flexibility, and neuromuscular training. These programs should be routinely evaluated and modified based on emerging evidence, ensuring both male and female players receive optimal care before and after injuries.\u003c/p\u003e \u003cp\u003eAs the data for this study were obtained from public online sources, there were several limitations inherent to this approach. Recent literature (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) has indicated that such online platforms may underreport the actual incidence of injuries among athletes. It is therefore possible that this study overlooked some injured players. Additionally, due to the lack of accessible medical records or imaging, information regarding associated injuries\u0026mdash;such as concomitant meniscus tears, collateral ligament damage, and articular cartilage injuries\u0026mdash;along with details about surgical techniques, graft selection, and rehabilitation programs, were unavailable. These factors could significantly influence players' recovery and performance following an ACL injury, and analyzing data that includes these variables would be beneficial. However, since a comprehensive injury database akin to those utilized in the NFL or NBA does not exist for European soccer, the sources we used represent the best available and independent option, having been effectively employed in similar research previously.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of this study indicate an association between gender and time needed to RTP after an ACL injury, however, no relationship between gender and subsequent ipsilateral or contralateral rupture were identified, nor the likelihood of returning to play or having a history of contralateral or ipsilateral ACL ruptures.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDM And FdC wrote the main paper, VS And AA retrieved all data, AC performed statistical analysis, PZ and AdC reviewed the manuscripts.\u003c/p\u003e\u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e\n\u003cp\u003eNo Funding was used for the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMart\u0026iacute;n-San Agust\u0026iacute;n R, Medina-Mirapeix F, Esteban-Catal\u0026aacute;n A, Escriche-Escuder A, S\u0026aacute;nchez-Barbadora M, Ben\u0026iacute;tez-Mart\u0026iacute;nez JC (2021) Epidemiology of Injuries in First Division Spanish Women's Soccer Players. Int J Environ Res Public Health 18(6):3009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18063009\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18063009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 33804081; PMCID: PMC8000692\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTenforde AS, Fredericson M (2011) Influence of Sports Participation on Bone Health in the Young Athlete: A Review of the Literature. Pm R 3:861\u0026ndash;867\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelge EW, Aagaard P, Jakobsen MD et al (2010) Recreational football training decreases risk factors for bone fractures in untrained premenopausal women. Scand J Med Sci Sports 20(S1):31\u0026ndash;39\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeabra A, Marques E, Brito J et al (2012) Muscle strength and soccer practice as major determinants of bone mineral density in adolescents. Joint Bone Spine 79(4):403\u0026ndash;408\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder AR, Martinez JC, Bay RC, Parsons JT, Sauers EL, Valovich McLeod TC (2010) Health-related quality of life differs between adolescent athletes and adolescent nonathletes. J Sport Rehabil 19(3):237\u0026ndash;248\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Gall F, Carling C, Reilly T (2008) Injuries in Young Elite Female Soccer Players: An 8-Season Prospective Study. Am J Sports Med 36:276\u0026ndash;284\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClausen MB, Zebis MK, M\u0026oslash;ller M, Krustrup P, H\u0026ouml;lmich P, Wedderkopp N, Andersen LL, Christensen KB, Thorborg K (2014) High Injury Incidence in Adolescent Female Soccer. Am J Sports Med 42:2487\u0026ndash;2494\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChilders J, Eng E, Lack B, Lin S, Knapik DM, Kaplan DJ, Jackson GR, Chahla J Reported Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes Is Greatest in Female Soccer Players and Athletes Participating in Club Sports: A Systematic Review and Meta-analysis. Arthroscopy. 2024 Apr 29:S0749-8063(24)00298-6. doi: 10.1016/j.arthro.2024.03.050. Epub ahead of print. PMID: 38692337\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eF\u0026auml;ltstr\u0026ouml;m A, H\u0026auml;gglund M, Kvist J (2024) Male football players have better patient-reported outcomes after primary anterior cruciate ligament reconstruction compared with females. BMC Sports Sci Med Rehabil 16(1):199. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13102-024-00996-1\u003c/span\u003e\u003cspan address=\"10.1186/s13102-024-00996-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 39322969; PMCID: PMC11426077.\u0026ugrave;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaga\u0026ntilde;a-Ram\u0026iacute;rez M, Gallardo-G\u0026oacute;mez D, \u0026Aacute;lvarez-Barbosa F, Corral-Pern\u0026iacute;a JA (2024) What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? A systematic review and network meta-analysis. J Sci Med Sport 27(4):234\u0026ndash;242\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eden Hollander S, Culvin A, Kerkhoffs G, Gouttebarge V (2024) Match workload and international travel associated with (ACL) injuries in professional women's football. Eur J Sport Sci 24(10):1423\u0026ndash;1431\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInclan PM, Chang PS, Mack CD et al Validity of research based on public data in sports medicine: a quantitative assessment of anterior cruciate ligament injuries in the National Football League [published online June 214, 2021]. Am J Sports Med.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ACL, RTP, soccer, female players","lastPublishedDoi":"10.21203/rs.3.rs-5469754/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5469754/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Women’s football has experienced significant growth, with approximately 29 million female players worldwide, emphasizing the need for research focused on injuries. Anterior cruciate ligament (ACL) ruptures are a major concern, particularly among elite players, and understanding gender differences in injury incidence and recovery is crucial for developing effective prevention and rehabilitation strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This retrospective study analyzed ACL injuries in male and female players from the top five European leagues (Serie A, Premier League, Ligue 1, La Liga, and Bundesliga) during the 2022-2023. A total of 169 players (71 female, 101 male) who underwent ACL reconstruction were included. Data on age, body mass index (BMI), injury history, affected side, playing position, and return-to-play (RTP) outcomes were collected. Statistical analyses were performed using SPSS® software with a significance level of P \u0026lt; .05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Female players had a significantly longer average RTP (300 days) compared to male players (248 days) (P \u0026lt; .001). Furthermore, 3.5% of female athletes did not return to play, while 12.2% of male athletes failed to achieve RTP (P = .028). The defender position had the highest non-return rate (25%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study highlights significant gender differences in ACL injury recovery in professional football. Female athletes face longer rehabilitation periods and greater challenges in returning to play, indicating a need for tailored injury management strategies and position-specific rehabilitation programs. Further research and targeted interventions are essential to improve outcomes for female players, enhancing safety and career longevity.\u003c/p\u003e","manuscriptTitle":"Acl Tears in Female and Male Professional Soccer Players","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-03 12:13:41","doi":"10.21203/rs.3.rs-5469754/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3af40d4f-3a5a-43a1-874d-daf93994518b","owner":[],"postedDate":"December 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-07T12:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-03 12:13:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5469754","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5469754","identity":"rs-5469754","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}