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Factors affecting return to play and graft re-rupture after primary ACL reconstruction in professional footballers

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Modern ACL reconstruction (ACL-R) techniques have led to improved outcomes in professional footballers. The aim of this study was to identify and assess patient, surgical and post-operative factors that affected rates and time to return to play (RTP) as well as ACL re-rupture rates.

Methods

A retrospective review of consecutive ACL-R undertaken in professional footballers between 2005 and 2018.

Results

Two-hundred and thirty-two knees in 215 professional footballers (17 bilateral) were included. 205 (88.9%) were male and average age at surgery was 23.3 ± 4.4 years. Two-hundred and twenty-two (96.1%) returned to professional football, with 209 (90.1%) returning to the same or higher Tegner level. Subgroup analysis revealed three factors that independently affected RTP rate: (1) Players under 25 years had a higher rate of RTP (99.3% vs 90.2%. p = 0.001); (2) a subsequent operation prior to RTP decreased RTP rate from 98.2 to 89.7% (p = 0.009).; (3) undergoing meniscal surgery at ACL-R decreased RTP rate (p = 0.002). The mean time to RTP from surgery was 10.5 ± 3.6 months. Factors found to increase RTP time included age under 25 (11.0 vs 9.7 months, p = 0.005), recurrent effusions (11.4 vs 10.2 months, p = 0.035), and medial meniscal repair at ACL-R compared to meniscectomy (12.5 vs 9.6 months, p = 0.022). The surgical technique varied over the study period in relation to graft type, femoral tunnel position and addition of lateral extra-articular tenodesis (LET). Overall, the re-rupture rate was 8.2% at 2 years. Patella tendon autograft in an anteromedial bundle femoral tunnel position with addition of LET has the lowest re-rupture rate (2.0%).

Conclusion

Primary ACL-R in professional footballers yields high rates of RTP (96.1%), with 90.1% at the same level or higher, at a mean 10.5 months. Patients under 25 years not only had a significantly higher RTP rate, but also had a lengthier period of rehabilitation.

Level of evidence

Level IV.

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Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK

    Ganesh Balendra, Mary Jones, Vitor Hugo Pinheiro & Andy Williams

  2. Houston Methodist Orthopedics and Sports Medicine, Houston, USA

    Kyle A. Borque

  3. Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Lukas Willinger

Authors
  1. Ganesh Balendra
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  2. Mary Jones
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  3. Kyle A. Borque
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  4. Lukas Willinger
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  5. Vitor Hugo Pinheiro
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  6. Andy Williams
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Contributions

GB & MJ participated in the design of the study, data collection and analysis and drafting the manuscript, KB participated in the design of the study and drafting the manuscript, LW participated in study design, performed the statistical analysis and review of the manuscript, VP participated in the data collection and review of the manuscript, AW conceived of the study and participated in drafting and reviewing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andy Williams.

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Conflict of interest

AW is an editorial board member of the AJSM and a shareholder in Innovate Orthopaedics. No other authors have any conflicts of interest.

Ethical approval

Approval to undertake the study was given by the institution involved in line with UK Health Research Authority guidance.

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Balendra, G., Jones, M., Borque, K.A. et al. Factors affecting return to play and graft re-rupture after primary ACL reconstruction in professional footballers. Knee Surg Sports Traumatol Arthrosc 30, 2200–2208 (2022). https://doi.org/10.1007/s00167-021-06765-8

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  • DOI: https://doi.org/10.1007/s00167-021-06765-8

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