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Review
. 2020 Oct 29;8(10):2325967120959654.
doi: 10.1177/2325967120959654. eCollection 2020 Oct.

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

Bailey J Ross  1 , Ian Savage-Elliott  2 , Symone M Brown  2 , Mary K Mulcahey  2
Affiliations
Review

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

Bailey J Ross et al. Orthop J Sports Med. .

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.

Keywords: ACL; football; injury; return to sport.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.K.M. has received educational support from Arthrex, Alon Medical Technology, and Quest Medical; nonconsulting fees from Arthrex; and hospitality payments from Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) flow diagram. ACL, anterior cruciate ligament; ACLR, ACL reconstruction; RTP, return to play. *Some articles were excluded for multiple reasons; therefore, the figures outlined in the exclusion explanations do not match the total articles excluded for each screening.
Figure 2.
Figure 2.
Return to play (RTP) rates in football players after anterior cruciate ligament reconstruction.
See this image and copyright information in PMC

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