Abstract
Objectives:
While advances in surgical technique have led to high levels of return to play in professional soccer players, little is known about their medium- and long-term career trajectory and performance.
Methods:
A retrospective review was performed of a consecutive series of primary ACL reconstructions in professional soccer players from the senior author’s practice, with a minimum of two-year follow-up. Clinical and performance measures were evaluated at 2- and 5-years post ACLR to determine pre- operative, operative and post-operative factors that affected player performance- measured by the level of league and number of minutes played.
Results:
200 male, soccer players were identified who were playing professionally at the time of their primary ACLR. The average age at the time of their primary ACL reconstruction was 24.1±4.2 years.
Additional injuries at the time of ACL rupture included 63 (32%) medial meniscus tears with 42 (67%) repaired, 134 (67%) lateral meniscus tears with 82 (62%) repaired, and 31 (16%) chondral lesions of grade 3 or higher. 194 (97%) athletes returned to play (RTP) at 10.7±3.9 months. Return to play was strictly defined as returning to a professional level. Eighteen (9%) athletes sustained a re-rupture at a median of 11.1 months (IQR 8.6-16.6 months) with 6 occurring pre-RTP and 12 post-RTP, while 52 (26%) sustained a contralateral ACL rupture during their soccer career.
At 2 years, performance metrics showed that 59% of athletes were playing in the same or higher-level league, while 15% were in a lower-level league but had more game appearances and minutes played than pre-injury. By 5 years 34% of athletes were playing in the same or higher-level league and 26% were in a lower-level league but had more game appearances and minutes played.
At 2 years, there were no significant predictors of performance when evaluating factors such as concomitant injuries, undergoing surgery after ACLR, or mechanism of injury. However, the presence of a grade 3 or 4 chondral lesion at the time of surgery significantly impacted both career length and performance with only 15% of athletes playing at the same or higher league at 5 years and these athletes were 3.5 times more likely to be playing at a lower league level or retired (p=.029). Meniscus repair lengthened the RTP timeline (11.6 months versus 9.8 months, p=.001), but no impact was seen at 5 years with league level or performance (all p>.05). No other injury characteristic predicted performance at 5 years post ACLR.
Conclusions:
While a high level of return to play, 97%, was achieved in professional soccer players following primary ACLR, their performance decreased with time. Performance metrics show 59% of athletes are at the same league level at 2 years and this decreases to 34% at 5 years post ACLR. Presence of a Grade 3 or 4 chondral lesion significantly decreased performance metrics, while a meniscus repair delayed RTP but did not impact performance metrics at 5 years post ACLR.
