Surgical Profiles of Elite Female Athletes and Their Association with Long-Term Musculoskeletal Health: Findings from the Women's Soccer Health Study

Purpose: To describe the career and post-career surgeries in female elite-level soccer players and evaluate their association with long-term musculoskeletal health. Study Design: This is a cross-sectional study. Methods: Surgical data (the number and type of surgeries during and after the career) from an anonymous online survey was obtained from a previously published cohort of 560 retired elite women’s soccer players. Correlation coefficients were used to evaluate the relationship between the number of surgeries and physical activity levels (UCLA activity scale), joint function (SANE), and physical and mental health (PROMIS-10), which were all collected on the same survey. Results: The average number of career surgeries was 1 (SD=1.6), and the average number of post-career surgeries was 0.5 (SD=1). The most common career surgery sites for women’s soccer players were knee (39%), foot/ankle (12%), and leg (4%). The most common knee procedures involved ligament reconstruction, primarily of the anterior cruciate ligament (ACL), followed by meniscus and cartilage surgery. The most frequent post-career surgery sites were knee (24.0%), foot/ankle (5.1%), and leg (3.2%). Knee ligament and meniscus surgeries were equally reported. More career and post-career surgeries were associated with lower SANE knee scores (p<0.001). Lower SANE knee scores (p=0.017) were associated with lower UCLA activity levels. Conclusions: The locations of career and post-career surgeries were similar, suggesting a possible association with long-term musculoskeletal impairment, particularly to the knee, in a cohort of mostly White collegiate former players. Having more soccer-related surgeries was associated with reduced joint function and activity levels after retirement, though the correlations were weak or moderate. These findings suggest the need for the development of preventive interventions that address the specific needs of female athletes, implementation of injury prevention programs and strategies to maximize adherence, and long-term musculoskeletal assessments of players after retirement.