Summary
After ACL reconstruction in elite soccer players, more than 92.3% return to sport and of these almost 80.1% return to their pre-injury level with a re-rupture rate of 8.2% and a mean return to sport at 263.20 days. In recent years, the return to professional soccer has been significantly slower than in the past by increasing by more than 40 percent.
Abstract
Background
Elite soccer players have a higher return to play (RTP) rate than other sports, ranging from 77% to 95%. The average time to return to play ranged from 6 to 13 months. Recent reports show that 86% of elite male soccer players continued to play soccer three years after anterior cruciate ligament reconstruction (ACLR), although only 65% competed at their pre-injury level. The aim of this systematic review and meta-analysis was to compare return to play, time to return to play, level of return to play and re-injury rate in professional soccer players from three different time periods.
Methods
The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant research articles that analyzed return to sport, time to return to sport, level of return to sport, and re-rupture rate in professional soccer players after ACL reconstruction. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. Four different outcome measures (return to sport, time to return to sport, level of return to sport and re-rupture rate) were extracted and meta-analyzed from all included studies and compared from three different time periods (before 2017, 2017-2021, after 2022).
Results
A total of 20 studies met the inclusion criteria and were included in the final analysis. Of these, five were published before 2017, five were published between 2017 and 2021, and ten were published after 2021. In total,1988 patients were included. The mean age of the professional soccer players at the time of surgery did not differ between the different time periods (p>0.05). 92.3% [95% CI 88.8 – 95.2] of elite soccer players returned to sport. No differences were found between the three different time periods (p>0.05). 80.1% [95% CI 65.5 – 91.5] of elite soccer players returned to their pre-injury level. Meta-analysis showed no difference (p>0.05) in the level of return to play rates between the different time periods, ranging from 75.6% (2022-2025) to 85.3% (2011-2016). ACL rupture was recorded in 146 (8.77%) of the 1663 elite soccer players. Meta-analysis showed no difference (p>0.05) in re-rupture rates between the different time periods, ranging from 10.4% (2017-2021) to 4.5% (2011-2016). Return to play rates ranged from 75.6% (2022-2025) to 85.3% (2011-2016). The mean time to return to play was estimated to be 263.20 days [95% CI 238.79 – 287.61]. The period 2022-2025 showed a lower return to play (295.06 days [95% CI 261.81 – 328.30]) compared to 2011-2016 (203.51 days [95% CI 147.73 – 259.29]; p=0.006).
Conclusions
After ACL reconstruction in elite soccer players, more than 92.3% return to sport and of these, almost 80.1% return to their pre-injury level, with a re-rupture rate of 8.2% and an average return to sport at 263.20 days. In recent years, the return to professional soccer has been significantly slower than in the past, with an increase of more than 40 percent while not significantly decreasing the re-rupture rates.