Return to play, performance, and career duration after anterior cruciate ligament rupture: A case-control study in the five biggest football nations in Europe

A media-based collection and further analysis of relative return to play (RTP) rates and the corresponding quality of play after anterior cruciate ligament (ACL) rupture in top-level football was the aim of our study. In the 5-year case-control study, male players from the first two leagues of the five top leagues in Europe, who sustained a total ACL rupture during the season 2010/11 and/or 2011/12, were included. For them and a matched control sample (ratio 1:2), data were retrieved from the publicly available and validated media-based platforms (transfermarkt.de & whoscored.com) until the end of season 2016/17. Injury and return to play-specific data were calculated as rate ratios (RR) to compare the injured and matched control athletes rates and as a survival analysis (log-rank test; career duration). Overall, 132 ACL-injuries in 125 players occurred. The RTP rate was 98.2%, and the RTP to the same level was 59.4%. Five years post-RTP, 69.9% of the ACL group were still engaged in football (RR = 87%), 40.9% at the same level (RR = 72%). Survival analysis revealed a systematic group difference in career duration compared to controls (Cox-Mantel's chi(2) = 5.8; P = 0.016). Game performance (scoring points, P < 0.001; rates/number of completed passes, P = 0.048; and minutes played, P < 0.001) was lower in the ACL athletes than in the matching group in the RTP and post-RTP seasons. Although absolute and relative RTP rates after ACL reconstruction are high in professional football, career duration and game performance are lower than in the reference group.