ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress ePoster #772


Playing Performance Among Australian Football League Players Following Anterior Cruciate Ligament Reconstruction

Courtney C. H. Lai, MBBS, BMedSc(Hons), Melbourne, VIC AUSTRALIA
Julian A. Feller, FRACS, Melbourne, VIC AUSTRALIA
Kate E. Webster, PhD, Melbourne, VIC AUSTRALIA

La Trobe University, Melbourne, VIC, AUSTRALIA

FDA Status Not Applicable


Based on objective measures, only 36 of 104 Australian Football League players following anterior cruciate ligament reconstruction returned to their pre-injury level of performance, but among those players who played at least ten senior matches in two seasons post-surgery, average performance returned to pre-injury levels in their second post-operative season.



Achieving pre-injury levels of athletic performance has been challenging for elite athletes returning to sport following anterior cruciate ligament (ACL) reconstruction. Although 77% of Australian Football League (AFL) players who underwent ACL reconstruction from 1999 to 2013 returned to play at least one further match at the highest level, this did not indicate how well they were able to play. This study aimed to objectively calculate the level of playing performance among AFL players who underwent ACL reconstruction, and to compare their post-surgical performance with their pre-injury performance.


158 AFL players who underwent ACL reconstruction between 1999 and 2013 were identified from a prospectively maintained registry. 104 players who had played at least ten AFL matches in one season prior to ACL injury were included for performance analysis. Ranking points, an overall measure of individual player performance devised by official AFL statisticians, were used as the primary measure of performance. Performance and demographic data were gathered from official AFL playing statistics, structured phone interviews, surgical records, and reputable AFL history websites.


36 of the 104 included AFL players (35%) returned to their pre-injury level of performance following ACL reconstruction. The odds of return to pre-injury performance were greater among players who were under 25 years of age at the time of initial ACL injury (OR = 2.9, p = 0.01), or under 90kg (OR = 2.7, p = 0.03). Among the 53 players who played at least ten AFL matches in two seasons following ACL reconstruction, the overall mean baseline level of performance was 80.6 ranking points per player per match. Overall mean performance decreased to 75.5 ranking points per player per match in the first post-operative season (p = 0.02), but increased to 79.5 ranking points per player per match in the second post-operative season, a level comparable with baseline performance (p=1.00).


Returning to play on a consistent basis was a substantial challenge for AFL players following ACL reconstruction. However, among players who did return to play consistently over two seasons, most returned to their pre-injury levels of performance, and their average level of performance post-surgery was comparable with the AFL average level of performance. Younger and lighter players were more likely to return to their pre-injury level of performance.