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Primary ACL Reconstruction in Professional Footballers: factors affecting return to play and re-rupture

2021 Congress Paper Abstracts

Primary ACL Reconstruction in Professional Footballers: factors affecting return to play and re-rupture

Kyle Borque, MD, UNITED STATES Ganesh Balendra, MBBS, AUSTRALIA Mary Jones, Msc Grad Dip Phys, UNITED KINGDOM Lukas Willinger, MD, GERMANY Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM

Fortius Clinic, London, UNITED KINGDOM

2021 Congress   ePoster Presentation     Not yet rated


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Summary: This case series of 232 ACL reconstructions performed in professional soccer players demonstrated high RTP and low re-rupture rates


The purpose of this study was to identify and assess patient, surgical, and post-operative factors that affect rates and times to return to play (RTP) in professional footballers (soccer players). The secondary objective was to evaluate how these variables affected ACL re-rupture rates in this challenging patient group.


A retrospective review of a consecutive series of isolated primary ACL reconstruction (ACL-R) undertaken by the senior author between January 1st 2005 and December 31st 2018 was conducted. All patients were professional footballers aged 17 years or older. The minimum follow-up was 2 years.


232 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. 150 (64.7%) involved patellar tendon (PT) autograft, 81 (34.9%) hamstring autograft and one (0.4%) PT allograft.

222 (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 the return to play rate. 1- Players under 25 years had a significantly higher rate of RTP than older footballers (99.3% versus 90.2%; p=0.001). 2- a subsequent operation prior to RTP decreased RTP rate (98.2% vs 89.7% (p = 0.009)). 3- medial meniscus repair at time of ACL-R reduced the RTP rate compared to meniscectomy (84% vs 100%, p = 0.017).

The mean time to RTP from ACL reconstruction was 10.5 ± 3.6 months. Factors found to significantly increase return to play 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 a subsequent operation before returning to play (13.4 vs 9.7 months, p= <0.001). In addition, medial meniscal repair at the time of the ACL-R, delayed RTP compared to those who underwent meniscectomy (12.5 vs 9.6 months, p=0.022).

The overall graft re-rupture rate was 8.3% - 12 (5.2%) occurred within the first year (5 before RTP). 7 (3.1%) re-ruptured between 1 - 2 years post-surgery. The surgical technique varied over the study period in relation to graft type femoral tunnel position, and addition of lateral extra-articular tenodesis (LET). PT autograft in an anteromedial (AM) bundle femoral tunnel position with the addition of LET) had the lowest re-rupture rate (2%)- the highest being 4 strand hamstring in the central (anatomic) femoral position without LET (18.5%). However, no factors were found individually to have a statistically significant effect on re-rupture rate.


Primary ACL reconstruction in professional soccer players yields high rates of return to play (over 95%) with 90.1% returning to the same or higher level at a mean 10.5 months. Players under 25 years old had a significantly higher RTP rate, but also increased time to RTP. Based in this evidence in order to minimise graft re-rupture rate the senior author’s preferred technique is PT autograft in the AM bundle femoral position plus LET.

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