Return to Play and Performance After Primary ACL Reconstruction in American Football Players: A Systematic Review

Abstract

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, and they can have a negative impact on players’ ability to return to play (RTP). There is a paucity of literature focused on RTP after ACL reconstruction (ACLR) in collision sports. Purpose: To characterize the impact that an ACL injury has on the ability to RTP and the post-ACLR performance level in American football players. Study Design: Systematic review; Level of evidence, 4. Methods: An electronic search was performed using the following databases: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Included studies were written in English; were published since the year 2000; examined only American football players; and reported on RTP, performance, and/or career length after primary ACLR. Results: The initial search yielded 442 unique studies. Of these, 427 were removed after screening, leaving 15 studies that met inclusion criteria. An additional 2 studies were identified in these studies’ references, yielding a total of 17. The rate of RTP after ACLR for football players was 67.2% (1249/1859), and the mean time to return was 11.6 months (range, 35.8-55.8 weeks). Although considerable heterogeneity existed in the study design and outcomes measured, in general, a majority of football players experienced greater declines from their preinjury performance level than controls over the same time period. Conclusion: An ACL injury negatively affected football players’ ability to RTP and their post-ACLR performance. The degree of effect varied by several factors, including playing position, preinjury performance level, and National Football League Draft round. These results may be used by physicians and football players to develop reasonable expectations for returning to play and performance after an ACL injury.

Preseason elimination impact on anterior cruciate ligament injury in the national football league

“…ACL tears are catastrophic and common injuries in football, with athletes estimated to have a ten times higher risk of rupture in participation when compared to other sports[ 2 ]. A recent systematic review reported the overall return to play rate in NFL athletes after an ACL tear at only 67.2%, with significant variability depending on the position and experience of the athlete[ 3 - 5 ]. Additionally, of players able to return, the financial impact of these injuries on player earning potentials is well documented, with salary losses of roughly $2 million per year after injury[ 6 ].…”

Biologic agents to optimize outcomes following ACL repair and reconstruction: A systematic review of clinical evidence

“…ACL tears are rather common, but they are perceived as serious injuries, which may significantly impact the career of athletes due to the recovery times required and to the risk of not restoring in full the pre-injury status of the knee. 49,50 Results following ACL surgery are extremely satisfactory but current evidence suggests that, besides the role of patient's individual risk factors, no specific technique, no graft choice, and no fixation device is able to provide superior outcomes. 51,52 Therefore, biologic augmentation soon came into play: as expected, the literature revealed that PRP-products are the most commonly used in this particular field, due to their easier preparation protocol and lower costs compared to cell-based approaches.…”

Composite Score of Readiness (CSR) as Holistic Profiling of Functional Deficits in Footballers Following ACL Reconstruction

“…Anterior cruciate ligament (ACL) injuries are very common in sports [1]. The most important goal for athletes after ACL reconstruction is a successful return to play [1,2].…”

“…Anterior cruciate ligament (ACL) injuries are very common in sports [1]. The most important goal for athletes after ACL reconstruction is a successful return to play [1,2]. It has been reported that from 78% to 98% of professional athletes, and 65% of amateurs, return to pre-injury level [3].…”