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

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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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