Return to play, performance, and career duration after
anterior cruciate ligament rupture: A case-control study in the five biggest
football nations in Europe.
Niederer D,
Engeroff T, Wilke J, Vogt L, Banzer W. Scand
J Med Sci Sports
. 2018. [Epub Ahead of Print].
Take Home Message: Elite soccer players have rates of high
return to play after an ACL reconstruction; however, it can take up to 2 years to return to a similar
performance level as their peers. Furthermore, they may be more likely to have
a shorter career than their peers.
While many patients
after an anterior cruciate ligament (ACL) reconstruction return to play, they
are at risk for serious long-term problems (e.g., re-injury, osteoarthritis),
which could adversely affect his/her performance level after returning to play.
Prior investigators have struggled to account for various factors that may
contribute to retirement or diminished performance after an ACL reconstruction.
Therefore, the authors looked at top-level European football (soccer) athletes
to compare return-to-play rates, career duration, and game performance of athletes
who underwent ACL reconstruction and matched control athletes. The athletes were
injured during the 2010/2011 and 2011/2012 seasons and followed for 5 years’
post-injury. The authors extracted patient demographics, injury history, and return-to-play
data from
They also extracted player performance data from For each injured
player, the authors selected 2 matched players with no history of knee injury
based on age, playing position, country of play, league of play, and market
value. Overall, the authors identified 132 ACL ruptures in 125 players (~25
years of age; 10% reinjury rate in 5 years) that resulted in a wide range of
games lost (1-90 games), and approximately 209 days between rupture and first
match appearance. Goal keepers and center backs returned quicker than forwards.
Overall, both groups had over a 90% of athletes return to play the next season.
However, players that suffered an ACL rupture had shorter careers than healthy
players. The authors also found that players with an ACL rupture had decreased
performance (minutes per season, scoring points) for up to 2 years after the

This study was
interesting because the authors found that though nearly all athletes returned
to sport in this population, players that underwent an ACL reconstruction had
poorer performance indicators and shorter careers than healthy peers. It would
be interesting to follow up and ascertain why players had earlier retirements
(life planning, pain, fear of reinjury). It was also interesting to note that position
may influence return-to-play time. More information about differences in
technical skills, neuromuscular performance, pressure to return between
positions could be helpful to individualize rehabilitation and return-to-play
programs. Lastly it is thought-provoking that impaired game performance only lingered
for up to 2 years after reconstruction, this could suggest that the real return
to performance for these elite players may take as long as 2 years. Medical
professionals need to consider this information to create programs for
long-term joint health. Furthermore, they may need to consider continuing ACL
rehabilitation beyond return to play and be pro-active to help prevent ACL
for Discussion
: Do you continue to work with athletes that had ACL reconstruction
after they returned to play? If so, what does your program consist of? Did you
notice a decline in reruptures?
Written by: Jane McDevitt
Reviewed by: Jeffrey