背景：體育活動對健康和福祉有關鍵貢獻，但也伴隨負面風險，尤其是運動傷害，已成為值得重視的公共衛生問題。在足球等高強度運動常導致下肢損傷，是影響運動員表現的主要因素，而女性運動員由於生理和生物力學的差異，更容易受到某些損傷，例如前十字韌帶（ACL）撕裂。儘管已知性別差異明顯，女性運動傷害的研究仍然有限，顯示存在明顯知識缺口，因此，本研究旨在探討運動傷害對精英級女足球員的職業生涯和滿意度的影響。
方法：本研究利用了美國 560 名退休精英女足球員的數據，按照美國體育職業水平劃分爲大學、半職業、職業和國家隊的球員。以 t 檢定和卡方檢定分析人口統計和傷害數據；透過皮爾森相關係數評估手術次數與單一作業數值評估 (SANE) 和加州大學洛杉磯分校 (UCLA) 活動量表分數之間的關聯，並進一步分析使用線性和邏輯迴歸模型來探討損傷和手術因素對職業持續時間和滿意度的影響。
結果：本研究顯示了職業生涯和退休後各種運動相關手術的比例相似。職業生涯中最常見的手術是膝關節韌帶（18%）、半月板（13%）和骨折（8%）；最常見的退休後手術是：半月板（9％）、膝關節韌帶（8％）、膝關節軟骨（5％）。較低的 SANE 膝蓋評分與較高的職業生涯和職業生涯後手術次數相關（p<0.0001）；較高的 SANE 膝蓋評分 (p=0.017) 和肩部評分 (p=0.022) 與較高程度的身體活動有關。非自願退休的球員報告了更多的職業手術（1.8 vs 0.9，p<0.001）。
線性多變量分析表明，較高的競爭水平仍然是精英職業生涯的獨立且顯著的預測因素（p < 0.001）。此外，退休年限的增加對縮短職業生涯有顯著影響（p = 0.018）。在序數迴歸分析中，作為一名後衛(p = 0.034)、退休年齡(p = 0.007)、退休年數(p = 0.027)、PROMIS-10 心理(p < 0.001) 和身體(p = 0.043) 均與職業生涯相關因素與較高的滿意度有顯著相關。然而，退休年齡和比賽位置並不是退休後滿意度的重要預測因素。與職業生涯相比，退休後較高的滿意度與 ACL 重建手術的表現 (p=0.034)、退休年數 (p<0.001) 以及 PROMIS-10 量表的心理健康狀況 (p<0.001) 有關，顯示了其獨立相關性高。
結論：這項研究調查了手術對優秀女足球員的長期影響，揭示了手術史、關節功能和職業滿意度之間的顯著關聯。個人職業生涯期間和之後進行的手術部位相似，顯示存在長期的肌肉骨骼損傷，特別是膝蓋損傷。進行更多與足球相關的手術與關節功能和活動水平較差以及非自願退休有關。 ACL 損傷對職業生涯結束後的較差的心理健康有獨立影響。這項發現進一步驗證了膝關節損傷對女足運動員的危害和重大影響，並强調了針對女性運動員制定有針對性的傷害預防策略的必要性。

Introduction: Sports participation plays a vital role in maintaining good health and well-being, but its negative effects, particularly sports injuries, cause significant public health concerns. In high-intensity sports, such as soccer, lower-limb injuries are a major factor affecting athlete performance, and female athletes are more susceptible to certain injuries, such as anterior cruciate ligament (ACL) tears, due to physiological and biomechanical differences. Despite these known sex differences, research on sports injuries in women remains limited, highlighting significant gaps in knowledge. This study aims to explore the impact of sports injuries on the careers and satisfaction of elite-level female soccer players.
Materials and methods: This study utilized data from 560 retired elite female soccer players in the United States, including those who participated on college, semi-professional, professional, and national teams. Demographic and injury data were analyzed using descriptive analysis. Associations between the number of surgeries and scores on the Single Assignment Numerical Evaluation (SANE) and University of California, Los Angeles (UCLA) Activity scales, were assessed through Pearson correlation coefficients. Further analysis used linear and logistic regression models to explore the impact of injury and surgical factors on career duration and satisfaction.
Results: This study showed a comparable proportion of various sports-related surgeries during the career and post-retirement. The most common surgeries during the career were knee ligament (18%), meniscus (13%), and fracture (8%). The most common post-retirement surgeries were: meniscus (9%), knee ligament (8%), and knee cartilage (5%). Lower SANE knee scores were associated with a higher number of career and post-career surgeries (p<0.0001). Higher SANE knee scores (p=0.017) and shoulder scores (p=0.022) were associated with higher levels of physical activity. Players who were involuntarily retired reported more career surgeries (1.8 vs 0.9, p<0.001).

Linear multivariate analysis showed that higher competition levels remained an independent and significant predictor of elite careers (p < 0.001). Furthermore, increasing years of retirement has a significant effect on shortening careers (p = 0.018). In ordinal regression analysis, being a defender (p = 0.034), retirement age (p = 0.007), years retired (p = 0.027), PROMIS-10 mental (p < 0.001), and physical (p = 0.043) were significantly associated with higher satisfaction regarding career-related factors. However, retirement age and playing position were not significant predictors of postretirement satisfaction. Compared to career satisfaction, post-retirement satisfaction was more strongly associated with outcomes following ACL reconstructive surgery (p=0.034), years in retirement (p<0.001), and mental health status on the PROMIS-10 scale (p<0.001). These results demonstrated an independently significant impact on satisfaction.
Discussion: This study highlighted the serious challenges elite female athletes face after injury and showed the need for improved injury prevention strategies. Analyzing how musculoskeletal injuries affect the career longevity and satisfaction of female soccer players builds on existing research to better address their health issues. The findings are expected to provide valuable information on preventing injuries, promoting recovery, and protecting female athletes. This research investigated the long-term effects of sports injuries on women while addressing sex disparities in the sports health literature to promote gender equity.
Conclusion: This study investigated the long-term effects of surgery on elite female soccer players, revealing significant associations between surgical history, joint function, and career satisfaction. The sites of surgery performed during and after the individual's career were similar, indicating long-term musculoskeletal damage, particularly to the knee. Having more soccer-related surgeries was associated with worse joint function and activity levels, as well as involuntary retirement. ACL injury showed an independent effect on post-career dissatisfaction. This finding further verifies the harm and significant impact of knee injuries on women’s soccer players and highlights the need for targeted injury prevention strategies for female athletes.

1. Amstutz HC; Thomas BJ; Jinnah R; Kim W; Grogan T; Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. Bone Joint Surg Am.1984;66(2):228-241.
2. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2021;45(7):596-606.
3. Ardern CL., Taylor NF, Feller JA, Webster KE. Fear of reinjury in people who have returned to sport after anterior cruciate ligament reconstruction surgery. J Sci Med Sport. 2012;15(6):488-495.
4. Arhos EK, Capin JJ, Buchanan TS, Snyder-Mackler L. Quadriceps Strength Symmetry Does Not Modify Gait Mechanisms After Reconstruction, Rehabilitation, and Return to Sport Training of the Anterior Cruciate Ligament. Am J Sports Med. 2021;49(2):417-425.
5. Arundale AJH, Silvers-Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going? J Orthop Res. 2022;40(1):43-54.
6. Atkinson HD, Johal P, Falworth MS, Ranawat VS, Dala-Ali B, Martin DK. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg. 2010;130(8):965-970.
7. Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg. 2022;31(12):2542-2553.
8. Belhaj K, Meftah S, Mahir L, Lmidmani F, Elfatimi A. Isokinetic imbalance of adductor-abductor hip muscles in professional soccer players with chronic adductor-related groin pain. Eur J Sport Sci. 2016;16(8):1226-1231.
9. Bisciotti GN, Chamari K, Cena E, et al. Anterior cruciate ligament injury risk factors in soccer. J Sports Med Phys Fitness. 2019;59(10):1724–1738.
10. Biz C, Nicoletti P, Baldin G, Bragazzi NL, Crimi A, Ruggieri P. Prevention of Hamstring Strain Injury (HSI) in Professional and Semi-Professional Soccer Teams: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(16).
11. Bodendorfer BM, Curley AJ, Kotler JA, et al. Outcomes after Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A systematic review and meta-analysis. Am J Sports Med. 2018;46(11):2798-2808.
12. Bonnel F, Toullec E, Mabit C, Tourne Y, Sofcot. Chronic ankle instability: biomechanics and pathomechanics of ligament injury and associated lesions. Orthop Traumatol Surg Res. 2010;96(4):424-432.
13. Borque KA, Laughlin MS, Hugo Pinheiro V, et al. The Effect of Primary ACL Reconstruction on Career Longevity in English Premier League and Championship Soccer Players Compared with Uninjured Controls: A Matched Cohort Analysis. Am J Sports Med. 2024;52(5):1183-1188.
14. Candela V, De Carli A, Longo UG, et al. Hip and Groin Pain in Soccer Players. Joints. 2019;7(4):182-187.
15. Chan KW, Ding BC, Mroczek KJ. Acute and chronic lateral ankle instability in the athlete. Bull NYU Hosp Jt Dis. 2011;69(1):17-26.
16. Cheng J, et al. Sex-based differences in the incidence of sports related concussion: systematic review and meta-analysis. Sports Health. 2019;11(6):486–91.
17. Chomiak J, Junge A, Peterson L, Dvorak J. Severe injuries in football players. Influencing factors. Am J Sports Med. 2000;28(5 Suppl):S58–S68.
18. Cohen B, Kleinhenz D, Schiller J, Tabaddor R. Understanding Athletic Pubalgia: A Review. R I Med J. 2016;99(10):31-35.
19. Cowley ES, Olenick AA, McNulty KL, Ross EZ. “Invisible Sportswomen”: The Sex Data Gap in Sport and Exercise Science Research. Women in Sport and Physical Activity Journal. 2021;29(2):146-151.
20. Dave U, Kinderknecht J, Cheng J, Santiago K, Jivanelli B, Ling DI. Systematic review and meta-analysis of sex-based differences for concussion incidence in soccer. Phys Sportsmed. 2022;50(1):11-19.
21. Del Buono A, Florio A, Boccanera MS, Maffulli N. Syndesmosis injuries of the ankle. Curr Rev Musculoskelet Med. 2013;6(4):313-319.
22. DiGiovanni BF, Partal G, Baumhauer JF. Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med. 2004;23(1):1-19.
23. Ding D, Lawson KD, Kolbe-Alexander TL, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):1311-1324.
24. Dizon P, Jeanfavre M, Leff G, Norton R. Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation. Sports (Basel). 2023;11(3).
25. Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med. 2001;35(6):402–408.
26. Dumont GD, Glenn RL, Battle NC, Thier ZT. Correlation of the Single-Assessment Numeric Evaluation (SANE) Score with Hip-Specific Patient-Reported Outcome Measures. Arthroscopy, sports medicine, and rehabilitation. 2021;3(2):e435–e440.
27. Eberbach H, Hohloch L, Feucht MJ, Konstantinidis L, Sudkamp NP, Zwingmann J. Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports. BMC Musculoskelet Disord. 2017;18(1):162.
28. Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional soccer (soccer). Am J Sports Med. 2011a;39(6):1226-1232.
29. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional soccer: the UEFA injury study. Br J Sports Med. 2011b;45(7):553-558.
30. Elattar O, Choi HR, Dills VD, Busconi B. Groin Injuries (Athletic Pubalgia) and Return to Play. Sports Health. 2016;8(4):313-323.
31. Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. J Sport Health Sci. 2017;6(3):262-270.
32. Ficek K, Gwiazdon P, Skowronek R, et al. Uncommon Bone Injuries in Soccer Players. J Hum Kinet. 2021;80:125-138.
33. Fuller CW, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection procedures in studies of soccer (soccer) injuries. Br J Sports Med. 2006;40(3):193-201.
34. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112-120.
35. Gomella P, Mufarrij P. Osteitis pubis: A rare cause of suprapubic pain. Rev Urol. 2017;19(3):156-163.
36. Guillaume DD, Rachel LG, Nicole CB, Zachary TT. Correlation of the Single-Assessment Numeric Evaluation (SANE) Score with Hip-Specific Patient-Reported Outcome Measures. Arthroscopy, Sports Medicine, and Rehabilitation. 2021;3(2):e435-e440.
37. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077-e1086.
38. Hallen A, Ekstrand J. Return to play following muscle injuries in professional soccerers. J Sports Sci. 2014;32(13):1229-1236.
39. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95: 103208.
40. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
41. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009;18(7):873-880.
42. Herriman M, Schweitzer ME, Volpp KG. The Need for an Intervention to Prevent Sports Injuries: Beyond "Rub Some Dirt on It". JAMA Pediatr. 2019;173(3):215-216.
43. Jain N, Murray D, Kemp S, Calder J. Frequency and trends in foot and ankle injuries within an English Premier League Soccer Club using a new impact factor of injury to identify a focus for injury prevention. Foot Ankle Surg. 2014;20(4):237-240.
44. Jokela A, Stenroos A, Kosola J, Valle X, Lempainen L. A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes. Ann Med. 2022;54(1):978-988.
45. Kasturi S, Szymonifka J, Burket JC, et al. Feasibility, Validity, and Reliability of the 10-item Patient Reported Outcomes Measurement Information System Global Health Short Form in Outpatients with Systemic Lupus Erythematosus. J. Rheumatol. 2018;45(3):397–404.
46. Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1019-1036.
47. Koch M, Klügl M, Frankewycz B, et al. Football-related injuries are the major reason for the career end of professional male football players. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3560-3568.
48. Lin CY, Casey E, Herman DC, Katz N, Tenforde AS. Sex Differences in Common Sports Injuries. PM R. 2018;10(10):1073-1082.
49. Ling DI, Hannafin JA, Prather H, et al. The Women's Soccer Health Study: From Head to Toe. Sports Med. 2023;53(10):2001-2010.
50. Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N, Denaro V. The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. Am J Sports Med. 2012;40(5):996-1005.
51. Lu W, Liu D, Cai Z, et al. Internal brace augmentation reconstruction versus standard anterior cruciate ligament reconstruction: a randomized controlled clinical trial study protocol. BMJ Open. 2023;13(12):e065254.
52. Luo H, Newton RU, Ma'ayah F, et al. Recreational soccer as sports medicine for middle-aged and older adults: a systematic review. BMJ Open Sport Exerc Med. 2018;4(1):e000336.
53. Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42(10):2363-2370.
54. Manojlovic M, Ninkovic S, Matic R, et al. Return to play and performance after anterior cruciate ligament reconstruction in soccer players: a systematic review of recent evidence. Sports Med. 2024;54(8):2097-2108.
55. Martinez JC, Mazerolle SM, Denegar CR, et al. Female adolescent athletes' attitudes and perspectives on injury prevention programs. J Sci Med Sport. 2017;20(2):146-151.
56. McCleery J, Diamond E, Kelly R, et al. Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes. Br J Sports Med. 2024;58:1107-1114.
57. Meehan WP, Weisskopf MG, Krishnan S, et al. Relation of anterior cruciate ligament tears to potential chronic cardiovascular diseases. Am J Cardiol. 2018;122(11):1879-1884.
58. Milton K, Gomersall SR, Schipperijn J. Let's get moving: the Global Status Report on Physical Activity 2022 calls for urgent action. J Sport Health Sci. 2023;12(1):5-6.
59. Miyamori T, Nagao M, Sawa R, et al. Playing soccer on artificial turf as a risk factor for fifth metatarsal stress fracture: a retrospective cohort study. BMJ Open. 2019;9(2):e022864.
60. Mørup-Petersen A, Skou ST, Holm CE, et al. Measurement properties of UCLA Activity Scale for hip and knee arthroplasty patients and translation and cultural adaptation into Danish. Acta Orthopaedica. 2021;92(6):681–688.
61. Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med. 2002;32(5):339-344.
62. Paterno MV, Rauh MJ, Schmitt LC, et al. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med. 2012;22(2):116-121.
63. Paul RW, Sonnier JH, Johnson EE, et al. Inequalities in the evaluation of male versus female athletes in sports medicine research: a systematic review. Am J Sports Med. 2023;51(12):3335-3342.
64. Pecina M, Bojanic I, Smoljanovic T, et al. Surgical treatment of diaphyseal stress fractures of the fifth metatarsal in competitive athletes: long-term follow-up and computerized pedobarographic analysis. J Am Podiatr Med Assoc. 2011;101(6):517-522.
65. Poulsen E, Goncalves GH, Bricca A, et al. Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med. 2019;53(23):1454-1463.
66. Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. 2008;36(1):122-128.
67. Schmitt LC, Paterno MV, Ford KR, et al. Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc. 2015;47(7):1426-1434.
68. Sinnige A, Sliepen M, Scheltinga MR, et al. A nationwide network to provide supervised exercise therapy and lifestyle counseling for all patients with non-communicable diseases: Chronic CareNet. Int J Environ Res Public Health. 2020;17(16).
69. Teixeira E, Silva C, Romero F, Miguel M, Vicente A. Severe Injuries of Former Portuguese Football Players: A Post-Career Burden? Sports (Basel). 2025;13(1):17. Published 2025 Jan 9.
70. Tins BJ, Garton M, Cassar-Pullicino VN, et al. Stress fracture of the pelvis and lower limbs including atypical femoral fractures—a review. Insights Imaging. 2015;6(1):97-110.
71. Tyler TF, Schmitt BM, Nicholas SJ, et al. Rehabilitation after hamstring-strain injury emphasizing eccentric strengthening at long muscle lengths: results of long-term follow-up. J Sport Rehabil. 2017;26(2):131-140.
72. Tyler TF, Silvers HJ, Gerhardt MB, et al. Groin injuries in sports medicine. Sports Health. 2010;2(3):231-236.
73. van Eekeren IC, van Bergen CJ, Sierevelt IN, et al. Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects: a 5- to 24-year follow-up study. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1311-1315.
74. Wentz L, Liu PY, Haymes E, et al. Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review. Mil Med. 2011;176(4):420-430.
75. Whittaker JL, Losciale JM, Juhl CB, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomized controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med. 2022;56(24):1406-1421.
76. Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861-1876.
77. Williams GN, Gangel TJ, Arciero RA, et al. Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery. Am J Sports Med. 1999;27(2):214-221.
78. Winterstein AP, McGuine TA, Carr KE, Hetzel SJ. Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients. Sports Health. 2013;5(6):523-529.
79. Wood DG, Packham I, Trikha SP, et al. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am. 2008;90(11):2365-2374.
80. World Health Organization. Physical activity. Published 2023. Accessed June 29, 2025. https://www.who.int/news-room/fact-sheets/detail/physical-activity
81. Yuill EA, Pajaczkowski JA, Howitt SD. Conservative care of sports hernias within soccer players: a case series. J Bodyw Mov Ther. 2012;16(4):540-548.
82. Zhang JK, Barron J, Arvesen J, et al. Effect of patient resilience and the Single Assessment Numeric Evaluation (SANE) score on return to sport following anterior cruciate ligament reconstruction surgery. Arch Bone Jt Surg. 2021;9(5):512-518.