Soccer injuries constitute an important public health problem and cause a high economic burden. Nevertheless, comprehensive data regarding injury costs in nonprofessional soccer are missing. The aim of this study was to determine which groups of nonprofessional soccer athletes, injury types, and injury situations caused high injury costs.

A cross-sectional, retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund (Suva). One year after the corresponding accident, every injury was linked to its costs and to the answers obtained in the interview about injury setting, injury characteristics, and injury causes. Finally, the costs of 702 injuries were analyzed.

The average cost of an injury in nonprofessional soccer amounted to €4030 (bias-corrected and accelerated 95% confidence interval (BCa 95%CI): 3427-4719). Persons aged 30 years and older experienced 35% of soccer injuries but accounted for 49% of all costs. A total of 58% of all costs were the result of injuries that occurred during amateur games. In particular, game injuries sustained by players in separate leagues for players aged 30+/40+ years led to high average costs of €8190 (BCa 95%CI: 5036-11,645). Knee injuries accounted for 25% of all injuries and were responsible for 53% of all costs. Although contact and foul play did not lead to above-average costs, twisting or turning situations were highly cost relevant, leading to an average sum of €7710 (BCa 95%CI: 5376-10,466) per injury.

Nonprofessional soccer players aged 30 years and older and particularly players in 30+/40+ leagues had above-average injury costs. Furthermore, the prevention of knee injuries, noncontact and nonfoul play injuries, and injuries caused by twisting and turning should be of highest priority in decreasing health care costs.

Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.

Soccer is the world's most popular sport and one that is physically demanding and highly competitive. Consequently, the rate of injuries resulting from this sport is only increasing. It is estimated that 2-20% of all such injuries are fractures, one-third of which are located in the lower extremities. The aim of this epidemiological study was to investigate the incidence of lower-leg fractures (LLFs) in Belgian soccer players and determine the possible risk factors that lead to them.

All injuries of players associated with the Royal Belgium Football Association (RBFA) were reported and collected in a nationwide registry. We retrospectively compared the incidence rate of and risk factors for LLFs in Belgian soccer players during two seasons, 1999-2000 and 2009-2010.

In total, 1600 fractures (3%) were located in the lower leg. After a decade, the number of LLFs remained unchanged. Ankle fractures were the most common (37%), followed by foot and tibia fractures (33% and 22%, respectively). The least common were fibula fractures, which accounted for just 9%. A higher incidence of every type of LLF was observed in older and amateur-level soccer players, when compared with their younger and professional counterparts. Male players experienced more tibia and foot fractures, whereas the incidences of ankle and fibula fractures were comparable with those in female soccer players. The vast majority of fractures occurred during soccer games.

Ankle fractures and foot fractures represented two-thirds of all fractures noted in this analysis. Male gender, recreational level and adult age were important risk factors for LLFs. After 10 years, the incidence of LLFs did not decrease. Given the socioeconomic impact of these injuries, improved prevention techniques are required to reduce their incidence, particularly with regard to the frequently occurring ankle and foot fractures in this population.

To estimate the economic cost of injuries in a population of US high school varsity athletes.

The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury.

Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading.

Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life).

The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10,432 per injury (95% CI $8062 to $13,449) in comprehensive costs. Sport and competition division were significant predictors of injury costs.

Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

Information about soccer injuries is required to develop prevention and rehabilitation programmes. Most soccer injuries occur in the lower extremities. This type of injury is reviewed here. Definitions of injury, injury rate, injury percentage, mechanism of injury, anatomical region of injury, type of injury, and severity of injury are summarised. In each section, a description and summary of the data are provided. Finally, the limitations of the studies and suggestions to improve the investigation of soccer injuries are provided.

This paper examines the literature dealing with oral-facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear.

It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies.

While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.

Football is one of the most popular sports worldwide. The frequency of football injuries is estimated to be approximately 10 to 35 per 1000 playing hours. The majority of injuries occur in the lower extremities, mainly in the knees and ankles; the number of head injuries is probably underestimated. The average cost for medical treatment per football injury is estimated to be $150 (U.S. dollars). Considering the number of active football players worldwide, the socioeconomic and financial consequences of injury are of such a proportion that a prevention program to reduce the incidence of injuries is urgently required. For this reason, an analysis of intrinsic (person-related) and extrinsic (environment-related) risk factors was undertaken based on a review of the current literature. It was concluded that the epidemiologic information regarding the sports medicine aspects of football injuries is inconsistent and far from complete because of the employment of heterogeneous methods, various definitions of injury, and different characteristics of the assessed teams. The aim of this study was to analyze the literature on the incidence of injuries and symptoms in football players, as well as to identify risk factors for injury and to demonstrate possibilities for injury prevention.

To describe the typical tibial diaphyseal fracture ("footballer's fracture") and to clarify the circumstances and mechanism of the injury.

In an attempt to obtain a detailed analysis of the types of injury suffered, and thereby highlight areas for prevention, 100 consecutive adult football players with a tibial diaphyseal fracture were studied prospectively. Details of the circumstances and mechanism of injury were collected using a questionnaire (response rate 85%). Treatments depended on the Gustilo classification, displacement, and axial stability. Long term follow up was performed until clinical healing to define the overall prognosis.

61% of players suffered a fracture of both the tibia and the fibula. Ninety five percent of the tibial fractures were transverse or short oblique and were caused by impact during a tackle. Radiographic evidence of bridging callus was better than a classification of the bony injury for predicting weeks to clinical healing. The delayed union and non-union incidence following this injury is low. One patient suffered symptomatic shortening. One patient suffered symptomatic angulation and two patients with nonunion required bone grafting.

Tibial fracture is an expensive injury. It prevents a young population from being employed and takes up valuable NHS resources. As 85% of players were wearing shin guards, it is likely that improvements in shin guard design could reduce the rate of tibial fracture.

We conducted a prospective study of soccer injuries during the Soccer America Dawn to Dark Indoor Soccer Tournament, which was organized by the Lake Placid Soccer Center, Lake Placid, New York, 1993. Eight hundred twenty-four players competed in open men's, open women's, over-30 men's, and mixed divisions. The overall rate of injury per 100 player hours was 4.44, with a rate of 5.79 in the open men's, 4.74 in the open women's, 2.73 in the over-30 men's, and 1.54 for the mixed divisions. The differences in injury rates for men versus women and men versus older men were not statistically significant. Twenty-five of the 38 injuries (65.8%) were mild, with 27 injuries (71.4%) occurring in the lower extremities. Ankle sprains were the most common injuries and combined ligamentous injuries to the knee were the most common severe injuries. As the injuries increased in severity, they were more likely to be noncontact injuries. The data demonstrate the low incidence of injury in male and female indoor soccer participants. The data also show the similarity in the types of injuries sustained by indoor and outdoor soccer players.

All injuries occurring over a 7-week period at a local indoor soccer arena were documented for analysis of incidence rates. All injury rates were calculated per 100 player-hours. The overall injury rates for male and female players were similar, 5.04 and 5.03, respectively. The lowest injury rate was found among the 19- to 24-year-old athletes and the highest injury rate was found among the oldest age group (> or = 25 years). Collision with another player was the most common activity at the time of injury, accounting for 31% of all injuries. The most common injury types were sprains and muscle contusions, both occurring at a rate of 1.1 injuries per 100 player-hours. Male players suffered a significantly higher rate of ankle ligament injuries compared with female players (1.24 versus 0.43, P < 0.05), while female players suffered a significantly higher rate of knee ligament injuries (0.87 versus 0.29, P < 0.01). Goalkeepers had injury rates (4.2) similar to players in nongoalkeeper positions (4.5).

Thirty-seven former football players of the Norwegian national team underwent a neurological and electroencephalographic (EEG) examination to investigate the incidence of head injuries due to heading the ball. Sixteen players complained of protracted and permanent symptoms commonly attributed to the post-concussional syndrome: headache, irritability, dizziness, lack of concentration and impaired memory. A significantly increased incidence of EEG abnormalities was found in players compared with matched controls. The high incidence of EEG changes is probably the result of a cumulative effect due to repeated head traumas.

Sixty-nine football players from six Norwegian First Division League Clubs underwent a neurologic and EEG examination to investigate the incidence of head injuries. A significantly increased incidence of EEG disturbances were found in the football players compared to matched controls. The disturbances were most pronounced among the youngest players. The higher incidence of EEG disturbances found in the football players is most likely due to neuronal damage caused by repeated minor head traumas.

In brief: Millions of US children participate in recreational activities, organized youth leagues, and interscholastic sports programs. Although they enjoy and obtain health benefits from these activities, 3% to 11% of these children are injured while participating in sports programs each year. Epidemiologic studies show that different sports pose different types and degrees of risk and that injuries among children differ from those among adolescents. An awareness of injury patterns in youth sports helps physicians and others who care for children to identify variables associated with injury. Measures must be taken in all youth sports programs to modify such variables in an effort to prevent injuries.

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is emphasized. The effect of age, sex, and intensity of play on injury rates is discussed. Our present knowledge of injury rate by anatomical site, player position, and the type of playing surface are reviewed. We examined the importance of player factors such as flexibility, joint laxity, weakness, and incomplete rehabilitation from other injuries. In addition, we reviewed the role played by inadequate equipment, field conditions, and rule violations. A successful program for soccer injury prevention is described, and guidelines for future soccer injury epidemiology research are proposed.

Between 1979 and 1982 there were 8640 accidents to registered soccer players in Finland. Of these, 552 (6.4%) affected the maxillofacial and dental regions. Medical records were located relating to 537 of these cases (97%). There were a total of 843 injuries, of which 681 (80.8%) affected the teeth or alveolar processes, and 95 (11.2%) were fractures of the lower or middle third of the facial skeleton. The most common cause of the accidents (in 86.4% of cases) was contact with another player. The mean cost of maxillofacial and dental injuries was over twice as high as the mean cost relating to all soccer injuries. The need for the use of mouthguards by soccer players to protect against such injuries is discussed.

In 1950, Wolin and his colleagues described nine patients who exhibited a "meniscoid" lesion of the ankle. He used this term to describe a mass of hyalinized tissue that formed following an inversion sprain of the ankle. This band of tissue was predisposed to trapping between the fibula and the talus. His patients presented with persistent pain and swelling over the anterior aspect of the ankle. In the last 3 years, four patients have presented with this lesion at the Methodist Sports Medicine Center in Indianapolis. They were all soccer players who had experienced repeated ankle sprains accompanied by persistent pain, swelling and trapping. Initially, these patients were treated with physical therapy, taping, and antiinflammatory medication. After 6 months of treatment, they continued to have symptoms and underwent arthroscopic examination. In each case a band of white, fibrous tissue was found during surgery and was removed. After an appropriate period of rehabilitation, all four patients returned to competition with a cessation of symptoms. However, one patient reported recurrent pain on rare occasions.

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is emphasized. The effect of age, sex, and intensity of play on injury rates is discussed. Our present knowledge of injury rate by anatomical site, player position, and the type of playing surface are reviewed. We examined the importance of player factors such as flexibility, joint laxity, weakness, and incomplete rehabilitation from other injuries. In addition, we reviewed the role played by inadequate equipment, field conditions, and rule violations. A successful program for soccer injury prevention is described, and guidelines for future soccer injury epidemiology research are proposed.

In brief: This study documents the types and frequency of injuries sustained in the 1984 Norway Cup-the largest soccer tournament in the world. During a total of 35,154 player-hours, 411 injuries and hyperventilatory conditions were recorded for the 1,016 boys' teams and 332 girls' teams participating. The injury rate was 8.9 and 17.6 per 1,000 player-hours for boys and girls, respectively. The overall injury rate for both sexes was 11.7 per 1,000 player-hours. Of total injuries 47% were contusions, 22% sprains, 18% lacerations, and 6% fractures. More than 60% of the injuries involved the lower extremities, 17% the head and neck, and 14% the upper extremities. The authors conclude that youth soccer, even on this highly competitive level, is a sport with few and mainly minor injuries.

The analysis of 6153 accidents reported to the insurance company of the French Rhône-Alpes Soccer Association, for the 1980-81 season was undertaken, providing a survey of acute pathology in French soccer accidents and an estimation of the cost of this pathology to French society. Findings from this study include: injuries--ankle sprain is the most common; fractures prevail in the young players pathology; exposure--the average risk is one accident for 20 matches; the highest risk is for the senior category; collisions with opponents is the main cause of accidents; the first 5 minutes of the second half have a peak of accidents; the players exposure is roughly the same whatever their position on the ground; risk--winter should not increase the risk if the matches are played under good conditions; the risk is unevenly distributed according to the level of practice; cost--the cost for France over 1 year was estimated at US$20,000,000 and the total number of sick leave days at 2000 years; games with several accidents are very common in January and for the adult category. Consequently, tightening up the safety measures would be a very good investment.

The present investigation analyses all the acute soccer injuries recorded in Finland during one year (1980). The mean follow-up time was 18 months. The calculated yearly injury incidence was 5.8%. No significant difference in the injury incidences between the two sexes could be detected. A major part, 64% of the injuries were located in the lower extremities. Fractures and dislocations accounted for 11% of all injuries. One quarter of the injuries were classified as mild, causing a playing disability shorter than a week. Most injuries occurred through physical contact with another player (p less than 0.001). The calculated median time of absence from practice after injury was 4 weeks.

All football injuries treated at the Emergency Department, Oslo City Hospital, 1329 patients, 1167 males and 162 females, were recorded for one year, accounting for 28.4% of all sports injuries. Most injuries seen were in the 15-19 years age group in females and 20-24 years age group in males; 68% of the females and 42% of the males (p less than 0.001) were below 20 years of age, and 87% of the injuries occurred in competitive football. During matches, 695 players were injured giving an incidence of 34.5 injuries/10,000 player matches. The injuries occurred all year with a peak in June. Sprains accounted for 41% of the injuries, 23% were contusions and 19% fractures. Most injuries (59%) affected the legs. Hospital admission was required for three females and 57 males. The football injuries required 1966 consultations and necessitated that 349 patients had to stay away from work for a total of 6137 days.