Summary
The study on 971 Swedish soccer players reveals that 53% return to competition after ACLR, predominantly after more than 12 months.
Abstract
Background
Anterior cruciate ligament (ACL) injuries are common in soccer, often leading to prolonged absence from play. Factors influencing rates and the timing for return to competition (RTC) remain unclear.
Purpose
To investigate rate and timing for return to soccer league games after ACL reconstruction (ACLR) in Swedish players, examining associations with sex, age, level, graft, and additional ACL surgery.
Study Design: Retrospective cohort study.
Method
Data from the Swedish National Knee Registry (SNKLR) and the Swedish Soccer Association's IT system (FOGIS) was used. The study cohort comprised 971 soccer players, 64% males, who underwent primary ACLR. Demographics, graft type, and surgical information were extracted from the SNKLR and game participation from FOGIS. Follow-up for RTC was conducted for 36 months, while additional ACLR follow-up was 3-7 years. Statistical analyses, including Kaplan-Meier survival curves and relative risk calculations, were employed to assess factors influencing RTC rates and timing.
Results
Out of the 971 players analyzed, 53% RTC within 3 years with no difference between males and females, at a mean 15 months (median 14 months) from surgery to the first game. Eleven (2%) players RTC <6 months from ACLR, 62 (12%) 6 – 9 months, 125 (24%) 9 – 12 months, and 331 (63%) >12 months. Patellar tendon (PT) grafts demonstrated superior performance, showing quicker returns and higher RTC rates (p=0.005) compared to hamstring (HR 0.63 (0.48–0.84)) and quadriceps tendon grafts (HR 0.53 (0.30–0.93)). Players competing in higher divisions pre-injury experienced significantly swifter and higher RTC rates (p < .001). Ninety-five (10%) had a registered additional ACLR. Players who RTC did not exhibit a significantly higher rate of revision (35 (7%) vs 25 (5%)). However, those who returned faced a heightened risk of contralateral ACLRs compared to those who did not RTC ((32 (6%) vs 4 (1%) RR 1.72 (1.59 – 1.96), p < .001).
Conclusion
The study reveals that 53% of soccer players RTC after ACLR, predominantly after more than 12 months. The RTC was higher and faster in high-level players and those receiving a PT graft. The slow RTC may contribute to the relatively low rate of additional ACLRs.