The Courtois Controversy Unraveled: Re-injury Uproar Erupts!

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THE CASE

Courtois, the goalkeeper (GK) for the white team, sustained an injury to his left knee joint on August the 10th, 2023, during regular training in preparation for the inaugural match of the 2023/24 league season against Athletic Club at San Mamés on August 12th, where the white team emerged victorious with a 0-2 scoreline :

Following the medical evaluation, the club disclosed the diagnosis to the public:

Left knee anterior cruciate ligament (ACL) rupture.

Despite Courtois having previously experienced a right knee injury (meniscus tear) in 2015 while playing for Chelsea FC, his ACL rupture in his left knee marks the first occurrence of such an injury in his entire medical history , becoming the most significant injury suffered by the player during his sporting career, causing him to be sidelined for 222 days during the recovery process:

It has been a global shock, leaving fans in disbelief, as when Courtois was poised to make his return to play, he endured yet another injury, this time to the meniscus (tear) of his contralateral or non-injured leg (NIL).

Therefore, the objective of this article is to BRIEFLY outline and discuss some hypothetical reasons behind the player's experience of this new injury.

ACL READAPTATION METHODS - Brief discussion

Currently, there is a wealth of scientific literature and evidence-based knowledge to effectively plan and effectively manage the rehabilitation process following an ACL rupture, both in the general population and notably within the context of football players . Additionally, novel treatments involving mesenchymal stem cells have emerged, facilitating and enhancing tendon-bone healing during the medical phase.

However, reports indicate that certain rehabilitation protocols may fall short in achieving successful ACL readaptation. This is primarily attributed to protocols that focus on addressing the injured leg (IL) without adequately considering the need for adaptation in the contralateral or non-injured leg (NIL).

Furthermore, to enhance the quality of the rehabilitation process following a player's injury, it is highly recommended, particularly in professional contexts where the misuse of money due to injury leave is a concern, to conduct thorough assessments of both legs' conditioning performance throughout a regular training season. This includes evaluating - IN BOTH LEGS or UNILATERAL - parameters such as maximum strength - eccentric and concentric -, muscle power, and explosive strength, among others. Establishing these baseline parameters serves as crucial reference points for comparison post-injury and as targets to achieve before returning to play.

Another important consideration before returning to play is ensuring that IL reaches at least 80% of its reference value. Equally critical is assessing NIL to ensure it has not experienced any detraining compared to the IL. In any case, a deficit of over 7% in the NIL relative to the IL should be carefully addressed.

To assess strength imbalances between the legs (knees), various tests and protocols are available, with one of the most widely used being the Isokinetics test (e.g., study 1 & study 2 ), supported by scientific evidence.

Although these tests may not be specifically tailored to sports functionality, they encompass the functional aspects of the knee, covering the entire range of flexion - extension in a controlled movement. This makes them excellent for comparing imbalances between both legs (IL vs NIL).

CONSEQUENCES

The repercussions of Courtois' recent injury in the Champions League could be severe, potentially leaving the team without one of the world's best goalkeepers. However, their direct rivals in the semifinal group 2, from which both teams are expected to advance to the 2023/24 Champions League Final, are facing similar challenges. Both Manchester City FC and FC Bayern Munich are contending with injuries to their first-choice goalkeepers, with EDERSON likely to return in April for Manchester City and NEUER expected to miss the remainder of the season for FC Bayern Munich.

As a result, Real Madrid CF will have to field LUNIN, who may not be the best option but is on par with the current top GK. Below are key statistics illustrating that LUNIN performs at a similar level to RAYA of Arsenal FC and EDERSON of Manchester City FC. Additionally, all three outperform the second-choice goalkeepers of Manchester City FC, STEFAN, and FC Bayern Munich, ULREICH.

ANNEX

SEASON 2023/24 GOALKEEPER PERFORMANCE

LUNIN

Club: Real Madrid CF; Matches played: 17; Minutes played: 2100; Goals conceded: 19; Goals conceded / minute x 100: 0.9; Clean sheet: 10; Clean sheet / minute x 100: 0.5.

EDERSON

Club: Mancheter City CF; Matches played: 36; Minutes played: 3124; Goals conceded: 31; Goals conceded / minute x 100: 1.0; Clean sheet: 12; Clean sheet / minute x 100: 0.4.

STEFAN

Club: Manchester City FC; Matches played: 11; Minutes played: 926; Goals conceded: 11; Goals conceded / minute x 100: 1.2; Clean sheet: 4; Clean sheet / minute x 100: 0.4.

ULREICH

Club: FC Bayern Munich; Matches played: 12; Minutes played: 1080; Goals conceded: 15; Goals conceded / minute x 100: 1.4; Clean sheet: 3; Clean sheet / minute x 100: 0.3.

RAYA

Club: Arsenal FC; Matches played: 29; Minutes played: 2640; Goals conceded: 23; Goals conceded / minute x 100: 0.9; Clean sheet: 13; Clean sheet / minute x 100: 0.5.