{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:05:48Z","timestamp":1784801148014,"version":"3.55.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Hypothesis\/Purpose:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Study Design:<\/jats:title>\n Cohort study; Level of evidence, 3.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n 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\n t<\/jats:italic>\n tests, multivariable logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards modeling.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 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;\n P<\/jats:italic>\n < .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]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/03635465261441252","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:24:46Z","timestamp":1779258286000},"page":"1592-1598","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer: A Retrospective Matched Cohort Study"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-0827","authenticated-orcid":false,"given":"Daniele","family":"Mazza","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic"},{"name":"Italian Football Federation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"De Carli","sequence":"additional","affiliation":[{"name":"Italian Football Federation, Rome, Italy"},{"name":"Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"De Carli","sequence":"additional","affiliation":[{"name":"Italian Football Federation, Rome, Italy"},{"name":"Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Gagliardo","sequence":"additional","affiliation":[{"name":"Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Suraci","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6211-6948","authenticated-orcid":false,"given":"Giorgio","family":"Liberati Petrucci","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Santoriello","sequence":"additional","affiliation":[{"name":"Italian Football Federation, Rome, Italy"},{"name":"Catholic University of the Sacred Heart, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Zeppilli","sequence":"additional","affiliation":[{"name":"Italian Football Federation, Rome, Italy"},{"name":"Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"12","key":"e_1_3_2_2_2","first-page":"794","article-title":"FIFA 11+: an effective programme to prevent football injuries","volume":"47","author":"Bizzini M","year":"2013","unstructured":"Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries. Br J Sports Med. 2013;47(12):794-795.","journal-title":"Br J Sports Med"},{"issue":"9","key":"e_1_3_2_3_2","first-page":"497","article-title":"Optimising the return to sport continuum after ACL reconstruction: a critical review of current perspectives and future directions","volume":"55","author":"Buckthorpe M","year":"2021","unstructured":"Buckthorpe M, Della Villa F, Davison M, Di Mattia S, Della Villa S. Optimising the return to sport continuum after ACL reconstruction: a critical review of current perspectives and future directions. Br J Sports Med. 2021;55(9):497-505.","journal-title":"Br J Sports Med"},{"issue":"1","key":"e_1_3_2_4_2","first-page":"5","article-title":"Update on functional recovery process for the injured athlete: return to sport continuum redefined","volume":"55","author":"Buckthorpe M","year":"2021","unstructured":"Buckthorpe M, Frizziero A, Roi GS. Update on functional recovery process for the injured athlete: return to sport continuum redefined. Br J Sports Med. 2021;55(1):5-6.","journal-title":"Br J Sports Med"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099616"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511402662"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101247"},{"issue":"7","key":"e_1_3_2_8_2","first-page":"384","article-title":"High rate of muscle re-injuries after ACL reconstruction in professional footballers: a 5-year prospective study","volume":"56","author":"Della Villa F","year":"2022","unstructured":"Della Villa F, H\u00e4gglund M, Della Villa S, Ekstrand J, Grassi A, Bahr R. High rate of muscle re-injuries after ACL reconstruction in professional footballers: a 5-year prospective study. Br J Sports Med. 2022;56(7):384-391.","journal-title":"Br J Sports Med"},{"issue":"1","key":"e_1_3_2_9_2","first-page":"11","article-title":"Injury rates decreased in men's professional football: an 18-year prospective study of 33,000 matches in the UEFA Elite Club Injury Study","volume":"56","author":"Ekstrand J","year":"2022","unstructured":"Ekstrand J, Spreco A, Bengtsson H. Injury rates decreased in men's professional football: an 18-year prospective study of 33,000 matches in the UEFA Elite Club Injury Study. Br J Sports Med. 2022;56(1):11-17.","journal-title":"Br J Sports Med"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096031"},{"issue":"6","key":"e_1_3_2_11_2","first-page":"1035","article-title":"The team physician and the return-to-play decision: a consensus statement\u20142022 update","volume":"54","author":"Herring SA","year":"2022","unstructured":"Herring SA, Kibler WB, Putukian M, et al. The team physician and the return-to-play decision: a consensus statement\u20142022 update. Med Sci Sports Exerc. 2022;54(6):1035-1047.","journal-title":"Med Sci Sports Exerc"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-095908"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-019-05499-x"},{"issue":"2","key":"e_1_3_2_14_2","first-page":"129","article-title":"Hip and knee kinematics and kinetics during landing tasks after anterior cruciate ligament reconstruction: a systematic review and meta-analysis","volume":"57","author":"Lepley AS","year":"2022","unstructured":"Lepley AS, Kuenze CM. Hip and knee kinematics and kinetics during landing tasks after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Athl Train. 2022;57(2):129-135.","journal-title":"J Athl Train"},{"issue":"5","key":"e_1_3_2_15_2","first-page":"1344","article-title":"Epidemiology of injuries in Major League Soccer: 2014\u20132019","volume":"50","author":"Morgan AM","year":"2022","unstructured":"Morgan AM, Curtis RM, Beaulieu-Jones BR, et al. Epidemiology of injuries in Major League Soccer: 2014\u20132019. Am J Sports Med. 2022;50(5):1344-1353.","journal-title":"Am J Sports Med"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515578252"},{"issue":"3","key":"e_1_3_2_17_2","first-page":"669","article-title":"Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport","volume":"47","author":"Paterno MV","year":"2019","unstructured":"Paterno MV, Schmitt LC, Ford KR, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2019;47(3):669-675.","journal-title":"Am J Sports Med"},{"issue":"2","key":"e_1_3_2_18_2","first-page":"321","article-title":"Efficacy of the FIFA 11+ injury prevention program in collegiate male soccer players","volume":"49","author":"Silvers-Granelli H","year":"2021","unstructured":"Silvers-Granelli H, Mandelbaum B, Adeniji O, et al. Efficacy of the FIFA 11+ injury prevention program in collegiate male soccer players. 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J Orthop Sports Phys Ther. 2022;52(5):304-314.","journal-title":"J Orthop Sports Phys Ther"},{"issue":"4","key":"e_1_3_2_20_2","first-page":"827","article-title":"Criteria-based return-to-sport rehabilitation after anterior cruciate ligament reconstruction: an integrative approach","volume":"53","author":"van Melick N","year":"2023","unstructured":"van Melick N, van Cingel REH, Tijssen M, et al. Criteria-based return-to-sport rehabilitation after anterior cruciate ligament reconstruction: an integrative approach. Sports Med. 2023;53(4):827-845.","journal-title":"Sports Med"},{"issue":"4","key":"e_1_3_2_21_2","first-page":"579","article-title":"Return to sport following anterior cruciate ligament reconstruction: a review of current recommendations","volume":"49","author":"Webster KE","year":"2019","unstructured":"Webster KE, Feller JA. Return to sport following anterior cruciate ligament reconstruction: a review of current recommendations. 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