Returning to Elite Football

This session included presentations on: Contemporary management of shoulder injuries in elite football; Return to elite football following hip arthroscopy; Return to play after meniscal surgery; From fibular fracture to France – lessons for accelerated bone healing; Conservative management of the Achilles tendon in elite football; Surgical aspects effecting RTP in foot and ankle; Return to play following treatment for disc pathology in elite football; and Rehab – criteria allowing safe return to play.

Many people play football and the modern game is more physically demanding, resulting in an increasing number of shoulder injuries. Although there may be a role for prehabilitation in risk reduction, conservative management options are limited. However, 80% of injuries can be managed arthroscopically, with predictable outcomes and RTP in 9–12 weeks. Following hip arthroscopy for FAI, the return to elite sport is good but investigation is needed to exclude other common causes of groin pain. Isometric strength testing is useful for diagnosis and follow-up. The lateral and medial menisci in the knee are involved shock absorbing, load transmission, lubrication, proprioception and stability. Whereas there is a predictable RTP following a medial meniscus tear, a lateral meniscus tear has a much longer RTP, has to be carefully managed and can be a career-limiting injury. Two case studies were presented to illustrate RTP following fibular fracture and Achilles injury. The critical time points for recovery after foot and ankle surgery were discussed, along with options to improve healing for ligaments, tendon and bone. The ideal management involves minimal surgical trauma, good elevation and wound healing followed by early movement of tendons and joints, whereas bones and ligaments need immobilisation. RTP should be according to the patient’s progress rather than time-driven goals. The key is a team approach and good communication. Footballers, just like the general public, suffer from discogenic pain. The treatment options are also much the same (80% will resolve with conservative management in 8–10 weeks), although for athletes the timelines are accelerated and thresholds for intervention are lowered. The main indication for surgery is discogenic radicular pain and surgery is necessary for treating progressive neurological loss and cauda equina syndrome. Rehab for RTP after ACL surgery is complex and multifactorial. It should include functionally driven rehab criterial and good communication builds confidence and competence.