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Ruptures of the anterior cruciate ligament (ACL) typically occur in professional football and epidemiological data about longitudinal injury development is needed. This practice-driven investigation of media-derived ACL data provides information about professional football over 10 years. Injury registration was based on "kicker" sports magazine information that have been recorded over one decade in a standardized manner. Only ACL ruptures in the first German football league were included when they could be verified by a second reliable source. Level of evidence: III. Fifty-seven primary ACL ruptures were verified in the first German football league during the seasons 2007/2008 to 2016/2017. Among them, six re-injuries were found. Mean age at the time of injury was 24.8 years (SD 3.8). 31% (

Introduction The coronavirus lockdown in 2020 resulted in a worldwide suspension of professional sports. The first major professional football league to restart after the lockdown was the German Bundesliga. This study investigates whether the injury incidence increased after the restart of the season with only 9 days of regular preparation time and without any friendly matches in comparison to three control periods. Materials and methods In a prospective cohort study, injury analysis (at least 1 day of absence from official football matches or training sessions) of the German Bundesliga registry was standardised according to Hägglund et al. (Br J Sports Med 39:340–346, 2005) and Fuller et al. (Clin J Sports Med 16:97–106, 2006) for data collection and to previous publications for the validated use of media sources for injury registration. The study period after the lockdown in May and June of the 2019–2020 season was compared to three control periods: the period directly before the lockdown, the beginning of the 2019–2020 season and the 2018–2019 season final. Results The nine match days after the restart of the 2019–2020 season showed an overall injury incidence of 4.9 per 1000 h football. This rate was significantly lower than that of the previous season final (9 last match days, overall injury incidence: 6.9 per 1000 h football; p p > 0.05) or the winter break (8 match days; incidence: 5.6/1000 h, p > 0.05). Conclusion The period after the unexpected break in the 2019–2020 season due to the coronavirus lockdown and the rapid return to competition showed no increase in the injury rate compared to the pre-lockdown period and a lower injury rate than in the previous season final. The unintentional mid-season rest with its potential for physical recovery and individual fitness training seems to have had a positive effect on injury occurrence.

Introduction Many professional football players sustain at least one severe injury over the course of their career. Because detailed epidemiological data on different severe injuries in professional football have been missing so far, this study describes the frequency and return-to-competition (RTC) periods of different types of severe football injuries. Material and methods This epidemiological investigation is a prospective standardised injury analysis based on national media longitudinal registration. Injuries were classified according to the consensus statement by Fuller et al. (2006). The analysis includes injuries sustained by players of the first German football league during the seasons 2014–2015 to 2017–2018. Level of evidence: II. Results Overall, 660 severe injuries were registered during the four seasons (mean 165 per season; 9.2 per season per team; incidence in 1000 h: 0.77). The body region most frequently affected by severe injury was the knee (30.0%; 49.5 injuries per season/SD 13.2) followed by the thigh (26.4%; 43.5 injuries/SD 4.2) and the ankle (16.7%; 27.5 injuries/SD 5.0). The distribution of injuries over the course of a season showed a trend for ACL ruptures to mainly occur at the beginning of a season (45.8%), overuse syndromes such as achillodynia (40.9%) and irritation of the knee (44.4%) during the winter months and severe muscle and ankle injuries at the end of a season. ACL ruptures showed the longest RTC durations (median 222 days). Conclusion This study presents detailed epidemiological data on severe injuries in professional football. The body region most frequently affected by severe injuries was the knee. Several types of severe injuries showed a seasonal injury pattern. The appropriate timing of RTC after an injury is one of the most important and complex decisions to be made. This study provides information on the typical time loss due to specific severe football injuries, which may serve as a guideline.

The present study aimed to investigate time trends of head injuries and their injury mechanisms since a rule change as monitoring may help to identify causes of head injuries and may advance head injury prevention efforts. Based on continuously recorded data from the German football magazine “kicker Sportmagazin®” as well as other media sources, a database of head injuries in the 1st German male Bundesliga was generated comprising 11 seasons (2006/07–2016/17). Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) were calculated. Time trends were analysed via linear regression. Two hundred thirty-eight match head injuries occurred (IR 1.77/1000 match hours, 95% CI 1.56–2.01). There were no significant seasonal changes, expressed as annual average year-on-year change, in IRs over the 11-year period for total head injuries (p=0.693), facial/head fractures (p=0.455), lacerations/abrasions (p=0.162), and head contusions (p=0.106). The annual average year-on-year increase for concussion was 6.4% (p=0.004). Five head injury mechanisms were identified. There were no seasonal changes in injury mechanisms over the study period. The concussion subcategory increased slightly over the seasons, which may either be a result of increasing match dynamics or raised awareness among team physicians and players.

OBJECTIVE: The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football.METHODS: Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis.RESULTS: In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10-0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24-0.84) were also reduced. Injury incidence decreased with increasing compliance.CONCLUSION: '11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02222025.

Purpose: despite being commonly used, the interaction between Functional Movement Screen (FMS™) score and injury in any elite football population has not been studied. The aim of the present study was to investigate the relationship between FMS™ score and non-contact injury among elite youth players from a Premier League football academy. Materials and methods: eighty-four players were screened during the pre-season period and non-contact injuries recorded prospectively for the entirety of the 2013/14 football season. Logistic regression analysis was utilized to explore the relationships between the individual sub-tests of the FMS™ and injury. Receiver operating characteristic (ROC) curves were used to assess the predictive value of the FMS™ composite score. Results: logistic regression revealed no relationships between score achieved on the individual sub-tests and injury. ROC curves indicated poor predictive ability of the composite score. Players scoring below the identified cut-off values (≤14 or ≤15 depending on injury type considered) were 0.66 (95%CI: 0.40-1.10), 0.70 (95%CI: 0.32-1.57) and 1.52 (95%CI: 0.50-4.61) times as likely to suffer ‘any’, ‘overuse’ and ‘severe’ injuries respectively than those who scored above the identified cut-off values. Conclusions: there was no relationship between FMS™ score and injury. It was unable to predict any non-contact injury among English Premier League youth academy players. Practical implications: The present findings suggest that the FMS™ should not be used for risk stratification among young elite soccer players since the composite score was unrelated to injury likelihood. However, the FMS™ may be useful in other ways. For example, it may provide useful information to applied practitioners when designing strength-training programs for groups of players they are unfamiliar with, as is often the case at the start of a new season.

Background The association between movement quality and injury is equivocal. No soccer-specific movement assessment has been prospectively investigated in relation to injury risk. Objectives To investigate the association between a soccer-specific movement-quality assessment and injury risk among semiprofessional soccer players. Methods In this prospective cohort study, semiprofessional soccer players (n = 306) from 12 clubs completed the Soccer Injury Movement Screen (SIMS) during the preseason period. Individual training/match exposure and noncontact time-loss injuries were recorded prospectively for the entirety of the 2016 season. Relative risks were calculated, and presented with 90% confidence intervals, for the SIMS composite and individual subtest scores from generalized linear models with Poisson distribution offset for exposure. Results When considering noncontact time-loss lower extremity injuries (primary level of analysis), there was a most likely trivial association with the SIMS composite score. Similarly, the SIMS composite score demonstrated most likely to likely trivial associations with all injury categories included in the secondary level of analysis (noncontact time-loss hip/groin, thigh, knee, and ankle injuries). When considering hamstring strains and ankle sprains specifically (tertiary level of analysis), the SIMS composite score demonstrated very likely trivial associations. A total of 262 noncontact time-loss injuries were recorded. The overall (training and match exposure combined) incidence of noncontact time-loss injury was 12/1000 hours. Conclusion The SIMS composite score demonstrated no association with any of the investigated categories of soccer-related injury. The SIMS composite score should not be used to group players into high- or low-risk groups. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2018;48(8):630-636. Epub 8 May 2018. doi:10.2519/jospt.2018.8037.

There is a lack of injury data for the population of veteran football players. Therefore, a prospective study was conducted to investigate injury incidences and characteristics. Over one season, injuries and exposure of 18 teams (n = 265 players, age: 44.2±7.3 years, BMI: 26.6±3.2 kg/m(2)) were documented. Sixty-three players sustained a total of 88 injuries during the season. The incidence of training injuries (4.5 per 1000 hours) was significantly lower than of match injuries (24.7 per 1000 hours). The majority of injuries (n = 73; 83%) were located at the lower extremities, 52 (47%) were muscle injuries. The injury incidence of veteran football players is similar to other male football players of different skill levels and age groups, indicating a need for the implementation of preventive measures. Prevention programmes should consider the specific injury characteristics, with more muscle injuries in this population compared with younger football players.

Objective To identify risk situations promoting head injuries in professional male football (soccer) and to investigate the impact of a rule change in 2006 punishing elbow-head contacts. Design Analysis of video sequences of head events leading to head injury. Participants Professional football players of the first male German Bundesliga. Main outcome measures Observational criteria of head impacts on video recordings (players' actions preceding head injuries, foul play-referee's decision and assessment of rater, ball possession, on-pitch medical treatment, and consequences of head impact). Results Three hundred thirty-four head injuries were reported in kicker Sportmagazin corresponding to an incidence rate of 2.25 (95% confidence interval 2.01-2.51) per 1000 player match hours. The injured player predominantly jumped (60%), headed the ball (36%), or ran forwards (20%); the noninjured players mainly jumped (64%), headed the ball (27%), or raised the elbow to the head (23%). Free ball situations (2 players challenge for the ball) caused most of the head injuries (81%). The players' action "raising the elbow" during a head injury seemed to be lower after the rule change. Conclusions Jumping for the ball with the intention of heading is the predominant action associated with head injury risk. Head injuries occur most often when players challenge for the ball in a header duel. As head injuries bear the potential risk of long-term health sequelae, the identification of situational circumstances is essential to develop preventative means in the future.

The warm-up programme "FIFA 11+" has been shown to reduce football injuries in different populations, but so far veteran players have not been investigated. Due to differences in age, skill level and gender, a simple transfer of these results to veteran football is not recommended. The purpose of this study was to investigate the preventive effects of the "FIFA 11+" in veteran football players. Twenty veteran football teams were recruited for a prospective 9-month (1 season) cluster-randomised trial. The intervention group (INT, n = 146; 45 ± 8 years) performed the "FIFA 11+" at the beginning of each training session, while the control group (CON, n = 119; 43 ± 6 years) followed its regular training routine. Player exposure hours and injuries were recorded according to an international consensus statement. No significant difference was found between INT and CON in overall injury incidence (incidence rate ratio [IRR]: 0.91 [0.64-1.48]; P = 0.89). Only severe injuries reached statistical significance with higher incidence in CON (IRR: 0.46 [0.21-0.97], P = 0.04). Regular conduction (i.e. once a week) of the "FIFA 11+" did not prevent injuries in veteran footballers under real training and competition circumstances. The lack of preventive effects is likely due to the too low overall frequency of training sessions.

BackgroundAbsolute numbers of head injuries in football (soccer) are considerable because of its high popularity and the large number of players. In 2006 a rule was changed to reduce head injuries. Players were given a red card (sent off) for intentional elbow-head contact.AimsTo describe the head injury mechanism and examine the effect of the rule change.MethodsBased on continuously recorded data from the German football magazine “kicker”, a database of all head injuries in the 1st German Male Bundesliga was generated comprising seasons 2000/01-2012/13. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) as well as incidence rate ratios (IRR) to assess differences before and after the rule change were calculated.Results356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours). Contact with another player caused most head injuries, more specifically because of head-head (34%) or elbow-head (17%) contacts. After the rule change, head injuries were reduced by 29% (IRR 0.71, 95% CI 0.57 to 0.86, p=0.002). Lacerations/abrasions declined by 42% (95% CI 0.39 to 0.85), concussions by 29% (95% CI 0.46 to 1.09), contusions by 18% (95% CI 0.43 to 1.55) and facial fractures by 16% (95% CI 0.55 to 1.28).ConclusionsThis rule change appeared to reduce the risk of head injuries in men’s professional football.

Summary Objective To date, magnetic resonance imaging (MRI) has been the method of choice to visualize meniscal ganglions; however, an MRI is quite costly. Studies have shown that high-resolution ultrasonography (HRUS) is an alternative form of investigative imaging with comparable accuracy. Aim To present a case where ultrasound was used to diagnose a medial meniscus ganglion and illustrate its usefulness in deciding on the subsequent therapeutic intervention. Design Case report. Setting Radiography department at the Anglo-European College of Chiropractic (AECC), Bournemouth. Subject A 30-year-old student with a 10-month history of right-sided knee pain and clinical suspicion of a medial meniscal cyst and concomitant medial meniscal lesion. Method HRUS of the right knee was used to confirm the clinical diagnosis. Complementary MRI was available. The author was able to observe the subsequent surgical intervention (knee arthroscopy). Result Ultrasound examination confirmed the clinical findings and offered additional information as to the extent of the cyst. Ultrasound could not assist in determining the size or the location of the medial meniscal lesion for which MRI was required. Although this was important for the management of the patient, the decision on the therapeutic procedure (knee arthroscopy) could have been made from the ultrasound findings alone. The MRI findings did not change the method/technique of the planned operative procedure. The arthroscopy confirmed all the MRI findings; additionally, it demonstrated the connection between the meniscal tear and meniscal cyst and a partial detachment of the anterior cruciate ligament at its proximal insertion site. Conclusion HRUS is rapid, low-cost and non-invasive. This case illustrates its reliability and usefulness in the detection, characterization and differentiation of meniscal cysts.

Context: The winter break in the top 2 German professional soccer leagues was shortened from 6.5 to 3.5 weeks in the 2009–2010 season. Objective: To investigate whether this change affected injury characteristics by comparing the second half of the 2008–2009 (long winter break) with the equivalent period in the 2009–2010 season (short winter break). Design: Prospective cohort study. Setting: German male professional soccer leagues. Patients or Other Participants: Seven professional German male soccer teams (184 players in the 2008–2009 season, 188 players in the 2009–2010 season). Main Outcome Measure(s): Injury incidences and injury characteristics (cause of injury, location, severity, type, diagnosis), including their monthly distribution, were recorded. Results: A total of 300 time-loss injuries (2008–2009 n = 151, 2009–2010 n = 149) occurred. The overall injury incidence per 1000 soccer hours was 5.90 (95% confidence interval = 5.03, 6.82) in 2008–2009 and 6.55 (5.58, 7.69) in 2009–2010. Match injuries per 1000 hours were 31.5 (25.0, 38.0) in the first season and 26.5 (20.2, 32.7) in the second season; the corresponding training values were 2.67 (2.08–3.44) and 3.98 (3.19–4.95), respectively. The training injury incidence (incidence rate ratio = 1.49 [95% confidence interval = 1.07, 2.08], P = .02) and the risk of sustaining a knee injury (incidence rate ratio = 1.66 [1.00, 2.76], P = .049) were higher in 2009–2010 after the short winter break; the incidence of moderate and severe injuries (time loss >7 days) trended higher (incidence rate ratio = 1.34 [0.96, 1.86], P = .09). Conclusions: Shortening the winter break from 6.5 to 3.5 weeks did not change the overall injury incidence; however, a higher number of training, knee, and possibly more severe injuries (time loss >7 days) occurred.