on grass, where males had six times higher total
injuries and female injuries were 4.3 times higher
(Soderman, 2001).SOCCER INJURY CHARACTERISTICS
ANKLE INJURY
- The mechanism of an ankle sprain is often an inver-
sion stress as the talus tilts in plantar flexion to
manage tasks such as pivoting, jumping, and hard
turns with the ball. In this position the anterior talo-
fibular ligament(ATFL) is at maximal tension and
most vulnerable to injury. The calcaneal fibular liga-
ment(CFL) and posterior talo-fibular ligament follow
in order of injury behind the ATFL. The spectrum of
severity ranges from a lateral ankle ligament stretch
(Grade 1) to partial tear (Grade 2) to complete tear
(Grade 3). - Medial ankle ligament injuries are much more rare
due to the dominant strength of the deltoid ligament.
Therefore, a medial ankle disruption suggests a high-
energy impact and will possibly demonstrate ankle
mortise alteration requiring surgical management for
fractures and follow a longer recovery period. - Soccer players are susceptible to high ankle injuries.
During collisions or contested balls, the ankle position
during impact can be in the talar neutral position, with
or without a slight lateral talar tilt. This predisposes
the athlete to greater stresses along the calcaneal fibu-
lar ligament and the inferior anterior tibial-fibular lig-
ament. Performing a proximal tib-fib “squeeze test”
with distal referred pain at the ankle or instability with
external foot rotation is suggestive for a high ankle
sprain. - In the ankle with persistent pain and swelling beyond
two weeks the differential diagnosis should include
talar dome lesions, such as osteochondral fractures or
a fracture to the lateral process of the talus. If clinical
suspicion is high an MRI should be done. - The injured soccer player with chronic anterior ankle
pain extending on to the midfoot who had an acute
axial loading of the fore- and midfoot (kick into the
turf) should be evaluated for a bifurcate ligament
injury, impingement syndrome (especially for repeat
ankle injuries) or Lisfranc fracture. If clinical suspi-
cion dictates and weight bearing X-rays of the
ankle/foot are normal then a MRI of the ankle/foot
should be done. - Posterior ankle pain or hind foot pain in a soccer ath-
lete should raise concern in the young athlete
(Engstrom, Johanoson, and Tornkvist, 1991; Schmidt-
Olsen et al, 1991; Albert, 1983; Nilsson and Roaas,
1978; National Collegiate Athletic Association, 2000;
Ekstrand and Gillquist, 1983) for Sever’s disease or
more commonly retrocalcaneal bursitis with indoor
soccer players who have a pattern of repetitive heel
trauma against the sideboards. Achilles tendinitis dif-
fers from the above two conditions by presenting sev-
eral centimeters proximally to the tendon insertion
into the calcaneus.- Chronic posterior ankle pain should draw concern for
a calcaneal stress fracture as evident by calcaneal
squeeze test or an os trigonum fracture. Both can be
verified by triple phase nuclear bone scan.
KNEE INJURY- Soccer players can experience the gamut of overuse
and acute knee problems. Youth players are prone to
Osgood-Schlatter disease or any other patello-femoral
tracking maladies seen in all running sports. Senior
soccer players will suffer collateral ligament and
meniscal injuries along with the pain of creeping
osteoarthritis or patellar chondromalacia.
•With the leg well grounded by the cleats of the soccer
shoe, rapid rotational and flexion changes of the trunk
or lower leg as in passing the soccer ball may produce
sudden rotation of the femur relative to the fixed leg
causing meniscal and/or knee ligament injuries. As
mentioned earlier, tackling is a high-risk maneuver
where knee ligament strain often occurs when a player
is tackled with the loaded leg secured to the ground. - Soccer causes a higher incidence of meniscus injuries,
but the extreme morbidity caused by ACL injuries has
generated broad investigational research interest. - Soccer players rupture their ACL through direct con-
tact or noncontact. The latter mechanism is the pre-
dominant means for ACL injury in most sports other
than skiing; however, Arendt and Dick (Arendt and
Dick, 1995) reported that male collegiate soccer play-
ers have an equal rate of contact versus noncontact
ACL injuries. Female collegiate soccer players follow
the usual trend for noncontact ACL injuries but as pre-
viously mentioned dominates the males in this injury
category. - The mechanism of noncontact ACL injury follows the
common pattern of deceleration coupled with pivoting
with internal or external rotation or the awkward land-
ing of a varus or valgus collapsed knee. (Boden et al
2000) studied the mechanism of ACL injury as they
investigated 85 athletes with ACL tears. They reported
72% of the ACL tears involved noncontact deceleration
occurring at an average knee flexion of 23oat foot strike.
(Delfico and Garrett 1998) write that at this angle of
knee flexion the maximal anterior tibial translation
528 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS