Introduction

The aim of this study was to determine which factors affect a professional footballer's return to play performance level after ACL reconstruction (ACL-R). Additionally, to report their playing performance at 2 and 5 years post ACL-R compared to their preinjury performance.

Methods

A retrospective review of a consecutive series of primary ACL-R undertaken in professional footballers between 2005 and 2019 was undertaken. Performance was determined by the number of minutes played and the league level compared to their pre-injury baseline. Playing time (minutes) was classified as same (within 20%), more, or less playing time for each season compared to the one year prior to surgery.

Results

Two hundred footballers (mean age 24.1 ± 4.2 years) were included. 194 (97%) returned to professional football.

At 2-years after ACL-R 61% of footballers were playing in the same/ higher league, 29% were playing in a lower league and 10% were not playing. At 5-years this was 35%, 37% and 28% respectively.

Forty-six percent of footballers were playing the same or more minutes as pre-injury at 2 years post-surgery, 51% were at 3 and 4 years but this reduced to 45% at 5 years.

The presence of >50% thickness chondral pathology, ACL-R lacking lateral extra-articular tenodesis and age over 25 years at surgery were all significant risk factors of worse performance rates after ACL-R.

Conclusion

While professional footballers achieved high initial RTP rates after ACL-R, with the majority returning to pre-operative levels of competition, significant decreases in performance rates were noted over time.