title: Injuries, Matches Missed and the Influence of Minimum Medical Standards in the A-League Professional Football: A 5-Year Prospective Study.
abstract: BACKGROUND
  Epidemiological data on the occurrence of time-loss injuries over several A-League seasons remains lacking, while the effect of the mandatory implementation of 'Minimum Medical Standards' as a part of the collective bargaining agreement (CBA) needs to be explored.
  
  
  OBJECTIVE
  To explore the 5 year evolution of hamstring, groin, knee, ankle and total time-loss injuries among professional footballers in the A-League; to evaluate the consequences of these time-loss injuries in terms of total matches missed and costs incurred; and to explore whether the mandatory implementation of 'Minimum Medical Standards' in the A-League had led to a decrease in the occurrence of total time-loss injuries and total matches missed.
  
  
  METHODS
  An observational prospective study has been carried out since 2008. Data were collected weekly during the seasons 2008 - 2009 to 2012 - 2013 through official match previews/reviews, official media releases, official websites and/or self-reports by players. Total and specific (hamstring, groin, knee and ankle) numbers of time-loss injuries and matches missed were obtained for each season and the related financial costs calculated.
  
  
  RESULTS
  The total number of time-loss injuries and matches missed rose from 129 and 506 respectively in 2008 - 2009 to 202 and 1110 in 2010 - 2011. Following the introduction of 'Minimum Medical Standards', both categories decreased (significantly for matches missed). These time-loss injuries and matches missed led to high costs of up to AUD$ 37,317,029.29 (2012 - 2013 season). The same trend was found for knee injuries, while hamstring and ankle injuries remained almost the same. However, time-loss due to groin injuries increased despite the introduction of "Minimum Medical Standards".
  
  
  CONCLUSIONS
  The introduction of "Minimum Medical Standards" in the A-League had a favorable effect on the number of total, hamstring, knee and ankle injuries and on the number of matches missed due to these injuries, but not on the number of groin injuries. The costs related to time-loss injuries and related matches missed remained high.
authors.affiliation: World Players' Union (FIFPro), Hoofddorp, The Netherlands; Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands ; Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands; Amsterdam Collaboration for Health & Safety in Sports (ACHSS), Academic Medical Center / VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gouttebarge
authors.affiliation: World Players' Union (FIFPro), Hoofddorp, The Netherlands; Professional Footballers Australia (PFA), Victoria, Australia.
authors.forename: Brendan A
authors.initials: BA
authors.lastname: Hughes Schwab
authors.affiliation: Professional Footballers Australia (PFA), Victoria, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Vivian
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands ; Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands; Amsterdam Collaboration for Health & Safety in Sports (ACHSS), Academic Medical Center / VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Gino
authors.initials: G
authors.lastname: M M J Kerkhoffs
keywords: Epidemiology; Injuries Guideline Adherence; Soccer; Wounds