Aim
To determine the effect of primary anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) using a hamstring (HS) or bone-patellar tendon-bone (BPTB) autograft on career longevity of professional football and rugby players by comparing them with an uninjured, matched, control cohort. The secondary aim was to determine the factors affecting career length.
Methods
A consecutive series of primary ACLR with LET performed by 3 surgeons between August 2012 and December 2022 were reviewed. Male, professional football and rugby players who had undergone ACLR with LET utilising a HS or BPTB autograft a minimum of 2 years previously and had professional match appearance data available were included. Minimum age was 17 years for football and 18 years for rugby players. Each player was matched with 5 uninjured players based on sport, league level, position, match appearances and minutes played in the season prior to injury. RTP, defined as first professional match appearance in the injured group or 9 months after equivalent operation date in the control group, and career longevity, defined as last professional match appearance, were compared. A Cox proportional hazards regression model was used to assess the impact of key factors on career length after injury.
Results
One hundred and thirty-four players were included. 60 (25 football and 35 rugby players) had HS autografts) and 74 (61 football and 13 rugby) had BPTB autografts. RTP rates were high (97%) in the injured group and compared favourably with the 93.8% of uninjured players still completing at 9 months after the equivalent operation date (P=0.21). There were no significant differences in continued match participation or minutes played between the injured and uninjured players at 2, 3, 4, or 5 years, regardless of graft type used. Compared to the uninjured group there was no increased risk of retirement due to ACL injury (Hazard ratio 0.924, [95% CI: 0.725 – 1.177], P=0.521).Rugby players had a significantly higher risk of retirement (Hazard ratio 2.845, [95% CI: 2.317 – 3.493], P<0.001) than football players and each additional year of age at injury was associated with a 12% increase in retirement risk. Players competing at the top level preoperatively had a 28% lower risk of retirement compared to lower-level players.
Conclusion
Following ACLR with LET professional football and rugby players have high rates of RTP and maintain career longevity equal to an uninjured player regardless of whether a BPTB or HS autograft is used.
