The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review

Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3109-3117. doi: 10.1007/s00167-018-5032-1. Epub 2018 Jun 28.


Purpose: Sport-specific, performance-based outcomes are increasingly used to improve evaluation of treatment efficacy in elite athletes; however, its usage in elite soccer may be limited. The purpose of this investigation is to (1) assess current outcome reporting in elite soccer; (2) identify any variability in reporting of outcomes; and (3) determine how sport-specific performance-based outcomes are utilized to assess treatment efficacy in elite soccer.

Methods: A systematic review of the Pubmed, MEDLINE, and Embase, Scopus, SportDiscus, CINAHL and HealthSource: Nursing databases was performed without limitation on publication year. Inclusion criteria were (1) reporting of outcomes after a (2) lower extremity injury in (3) elite soccer players. The study's population, type of injury, return to play, as well as functional, objective, and sport-specific performance-based outcomes were extracted from each article. The methodological index for nonrandomized studies was used for quality assessment.

Results: Twenty-one studies were selected after application of the inclusion and exclusion criteria. Objective outcomes were reported by 6 (29%) studies, and 6 (29%) employed patient-reported outcomes. The visual analog scale, Lysholm, and Tegner scores were the most common patient-reported outcomes (PROs). Return to play was reported by 18 (86%) studies, and only 2 (10%) utilized sport-specific performance-based outcomes. Despite the majority of studies reporting return to play, variation was seen in the definitions, and 15 (71%) studies reported the activity level of the players at final follow-up.

Conclusion: Assessment of treatment efficacy is limited in elite athletes, and PROs lack the sensitivity to identify residual performance deficits after an injury. Although performance-based measures are available at the elite level, these outcomes were seldom used for evaluation of treatment efficacy.

Clinical relevance: When treating elite soccer players, patient-reported outcome measures lack the sensitivity to detect changes in patient function, thus performance-based metrics may be more efficacious in assessing return from injury in these patients.

Level of evidence: IV.

Keywords: Elite soccer; Major league soccer; Outcomes; Performance-based outcomes; Return to play.

Publication types

  • Systematic Review

MeSH terms

  • Athletes
  • Athletic Injuries / diagnosis*
  • Athletic Injuries / rehabilitation*
  • Humans
  • Lower Extremity / injuries*
  • Patient Reported Outcome Measures
  • Return to Sport
  • Soccer / injuries*
  • Treatment Outcome