Fatigue affects quality of movement more in ACL-reconstructed soccer players than in healthy soccer players

Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):549-555. doi: 10.1007/s00167-018-5149-2. Epub 2018 Sep 27.


Purpose: Athletes who meet return to play (RTP) criteria after anterior cruciate ligament reconstruction (ACLR) rehabilitation still have a substantially increased risk of second ACL injury. One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in an ecologically valid environment and in a fatigued state. The purpose of this cross-sectional case-control study was to investigate the influence of neuromuscular fatigue on both movement quantity and quality in fully-rehabilitated soccer players after ACLR and to compare them with healthy soccer players.

Methods: ACL-reconstructed soccer players (n = 14) and healthy soccer players (n = 19) participated in the study and were matched by playing level and training hours. RTP measurements were performed on the soccer field, in both a non-fatigued and fatigued state. The RTP measurements focussed on both movement quantity (hop tests) and quality [countermovement jump with a Landing Error Scoring System (LESS) score].

Results: Movement quantity did not differ between ACL-reconstructed and healthy soccer players, both expressed in absolute values and the LSI-D/ND (calculated as dominant/non-dominant*100%). However, movement quality decreased more in the ACL-reconstructed soccer players in the fatigued state compared to the non-fatigued state.

Conclusions: Ideally, RTP measurements should focus on movement quality and should be conducted on the soccer field in a fatigued state, creating an ecologically valid environment. The LSI-D/ND can be used as an outcome parameter for RTP measurements of movement quantity and should be at least 95%.

Level of evidence: Therapeutic, Level III.

Keywords: Anterior cruciate ligament reconstruction; Movement quality; Movement quantity; Neuromuscular fatigue.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / psychology*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction
  • Case-Control Studies
  • Cross-Sectional Studies
  • Fatigue*
  • Humans
  • Male
  • Movement*
  • Return to Sport*
  • Soccer / injuries*
  • Young Adult