Return to Play Rates in NFL Wide Receivers and Running Backs After ACL Reconstruction: An Updated Analysis

Anterior Cruciate Ligament Tears among Football Players

PURPOSE OF REVIEW

Anterior Cruciate Ligament (ACL) tears are one of the most common causes of lost playing time in American football athletes. Recently, there has been a push to get athletes back to sport faster. As such, numerous studies have evaluated management and rehabilitation protocols for return to play after ACL injury in football players. The purpose of this review is to synthesize information, both classic and new, to aid orthopedic surgeons in treatment of football players with ACL injuries.

RECENT FINDINGS

Recent studies have demonstrated that not all ACL injuries are alike. Management should be a shared decision-making process between athlete and surgeon. Studies have demonstrated low failure rates when using bone-patellar tendon-bone (BTPB) autograft which is the most common graft utilized for elite football athletes. Outcomes are continually being evaluated by multicenter study groups such as the Multicenter Orthopaedic Outcome Network which has established a thorough rehabilitation protocol focusing on athlete milestones. ACL tears in the football athlete are common and challenging injuries. Treatment revolves around ACL reconstruction, most commonly with BTPB autograft. Post-operative rehabilitation is essential and should focus on objective criteria rather than time elapsed. Return to play criteria rely upon symptoms, athlete confidence, strength, and both functional and football specific testing. Return-to-play timelines are individualized for each football athlete but recent trends have highlighted a more delayed return of at least 7-9 months. Rate of returning to play varies from 63-82% and depends upon many factors including level of play and position.

Anterior Cruciate Ligament Return to Play: "A Framework for Decision Making"

Anterior cruciate ligament (ACL) injury is common in athletic individuals and often leads to physical impairments, a low rate of return to performance, reinjuries, and sometimes reductions in career length [...].

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence

BACKGROUND

The available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR.

OBJECTIVE

The aim of this systematic review was to examine RTP and the performance of soccer players after ACLR.

METHODS

Three electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Databases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years.

CONCLUSION

Although a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.

Anterior Cruciate Ligament Injury Prevention and Rehabilitation

At all levels of American football, knee injuries are common, with injuries to the anterior cruciate ligament (ACL) making up a significant proportion. Historically, ACL injuries were career-altering for professional players, but innovative techniques in surgery and rehabilitation have returned many to the field. While there is a consensus on surgical techniques for ACL reconstruction, significant discrepancies remain on injury prevention and rehabilitation programs. This review article describes the burden of ACL injury on players in the National Football League, best practices in injury prevention and rehabilitation, and evidence-based recommendations for preparing injured athletes to return to play.

National Football League Wide Receivers and Running Backs Have Decreased Production Following ACL Reconstruction: An Evaluation of Fantasy Football Performance as an Outcome Measure

Purpose

To use fantasy football points as a simple measure alongside on-field statistics to compare performance in National Football League (NFL) offensive skill position players before and after anterior cruciate ligament (ACL) reconstruction.

Methods

A retrospective review of all NFL quarterbacks (QB), running backs (RB), wide receivers (WR), and tight ends (TE) who sustained an isolated, unilateral ACL injury from 1988 to 2017 was conducted. Data were collected from public data sources, team releases, NFL injury reports, press releases, and other Internet resources. For each player, a matched control with similar demographics was identified. Their in-game performance post-ACL reconstruction was analyzed using fantasy football points as an outcome measure.

Results

A total of 13 QBs, 30 RBs, and 29 WRs who underwent ACL reconstruction from 1988 to 2017 and who met inclusion criteria were retrospectively identified and reviewed. Of the 13 quarterbacks included in the study, there was no statistically significant difference in fantasy football points between the pre- and post-ACL reconstruction groups, as well as post-ACL and matched control groups. There was a statistically significant decrease in career fantasy football performance of running backs post-ACL reconstruction compared with matched control groups (129.6 vs 553.6; P < .0001). There was also a statistically significant decrease in per game fantasy football points post-ACL reconstruction (4.4 vs 11.2; P < .0001). Lastly, WRs also demonstrated a decrease in career fantasy football performance post-ACL reconstruction compared with matched controls (145.3 vs 460.9; P = .002). In addition, they also had a decrease in per game fantasy football performance (5.0 vs 7.7; P = .042).

Conclusions

Quarterbacks did not have a statistically significant decrease in performance following ACL reconstruction based on fantasy football performance. Conversely, both running backs and wide receivers had decreased per game and career performance post-ACL reconstruction based on their fantasy football statistics. Furthermore, RBs had the largest decline in production each season over a 3-year period following ACLR compared to QBs and WRs, respectively.

Level of Evidence

Level III, case-control study.