High risk of further ACL injury for players that return to football after ACL reconstruction

For football players sustaining an anterior cruciate ligament (ACL) rupture reconstructive surgery is often performed to restore knee stability and allow a return to football. This FastFact highlights a ten-year follow up of ACL reconstructed football players and investigates the ability to return to football and risk of further ACL injuries1.

The aim of the study was to follow up on football players ten years after a primary ACL reconstruction to find out how many players returned to football, what influenced their decisions about return to play, and to see whether there are any differences in new ACL injuries between those who returned to play and those who did not. Of the 684 players from the Swedish National Knee Ligament Registry that participated in the study 51% returned to football, 32% to the same or higher level and 18% to a lower level than before the injury. For the 49% that did not return to football 32% did so primarily due to reasons related to the operated knee and the remaining 17% quit primarily for reasons unrelated to the knee injury. The most common knee-related reasons for not returning were pain and/or instability (16%), followed by fear of reinjury (10%). Younger players were more likely to return to football but there was no significant difference between men and women. All the players in the highest division returned to football but return rate dropped with every level of play and at the recreational level only one in four got back to football. The players that returned continued playing for on average five years and 20% were still playing after ten years.

The main finding in this study is that players who return to football have a significantly higher risk of further ACL injury compared to those that did not return to football after ACL reconstruction. Of the players who returned to football, 28.7% (odds ratio [OR] 2.3, p < .001) reported that they had additional ACL injury, 9.7% (OR 2.9, p < .001) had a graft failure and 20.6% (OR 2.1, p < .001) had a contralateral ACL injury. The high risk of sustaining additional ACL injury is of serious concern to the players future knee health and should be considered when deciding on a return to play.

To learn more about the management of ACL injuries complete the Anterior Cruciate Ligament module in the FIFA Diploma in Football Medicine.

1Sandon A, Engstrom B, Forssblad M. High Risk of Further ACL Injury in a 10-Year Follow-up Study of ACL-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry. Arthroscopy. 2019. Epub 2019/08/24. doi: 10.1016/j.arthro.2019.05.052.


4 Comment threads
0 Thread replies
Most reacted comment
Hottest comment thread
3 Comment authors
ALIREZA KESHMIRIAntonio MaestroCamilo Andrés Villamizar Sierra Recent comment authors
newest oldest most voted
Notify of
Camilo Andrés Villamizar Sierra
Camilo Andrés Villamizar Sierra

¿cual seria una propuesta real desde la prevención para que el jugador disminuya el riesgo de relesión del LCA?

Antonio Maestro
Antonio Maestro

So, the most important thing could be te time for returning? have we wait more time for returning?
It’s really graft depending (thinking on a correct technique) or only sport depending?. In these case football but only for football players or more sports?.
Thank you