Related Experiment Video
Updated: May 21, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional
Daniele Mazza1,2, Angelo De Carli2,3, Francesco De Carli2,3
1Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
Background:
Professional soccer players who return to play after anterior cruciate ligament reconstruction (ACLR) often experience secondary muscle injuries, but the true incidence, timing, and contributing factors remain incompletely defined.
Hypothesis/Purpose:
It was hypothesized that soccer players returning after ACLR would show a higher incidence of secondary muscle injuries than matched controls, with an increased risk associated with premature return to play (RTP). The purpose of this study was to identify the incidence and risk factors for muscle injuries after ACLR and to evaluate their impact on athletic performance.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 40 professional male soccer players who underwent ACLR between 2020 and 2023 were followed for 24 months after RTP. Players were matched 1:1 to controls based on age, position, league, and preinjury minutes played. Collected variables included RTP timing, muscle injury incidence and timing, injury characteristics, performance metrics (minutes played, goals/assists, defensive actions), and market value changes. Analyses included paired t tests, multivariable logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards modeling.
Results:
Within 12 months of RTP, 13 of 40 players (32.5%) in the ACLR group sustained at least one secondary muscle injury compared with 5 of 40 players (12.5%) in the control group (incidence rate ratio, 2.60; P < .001). The injury risk peaked between 3 and 6 months after RTP. RTP in <9 months was a strong independent predictor of a secondary muscle injury (adjusted odds ratio, 4.85 [95% CI, 2.12-11.07]).
Conclusion:
Professional soccer players returning to play after ACLR face a substantially elevated risk of secondary muscle injuries, particularly within the first 3 to 6 months. Premature RTP is a key modifiable risk factor.