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Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction

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posted on 2022-05-20, 05:37 authored by Kate WebsterKate Webster, Haydn KlemmHaydn Klemm, Julian FellerJulian Feller
Background: Return to sport is a goal for most patients who undergo anterior cruciate ligament (ACL) reconstruction. However, at a nonelite level, there are limited sport-specific data regarding rates or factors associated with return to play. Purpose: To report rates and determinants of returning to play Australian Rules football after ACL reconstruction in male nonprofessional athletes. Study Design: Case-series; Level of evidence, 4. Methods: A total of 354 male nonprofessional Australian Rules football players who had undergone primary ACL reconstruction were asked to complete detailed sports activity questions at 12 months and 2 to 5 years (mean, 3 years) after surgery. Rates of return to play were calculated for both timepoints, along with preoperative patient expectations and postoperative sport performance. The following predictors of return to play were examined: age at surgery; height; weight; frequency of weekly football participation; sport participation level; psychological readiness to return to sport; and knee-related quality of life. Further ACL injuries were also documented. Descriptive statistics were used to summarize return-to-play data and contingency analysis for predictors of return to sport. Results: The rate of return to any level of play was 35% (95% CI, 30%-41%; n = 284) at the 12-month follow-up and 78% (95% CI, 72%-83%; n = 233) at the 2- to 5-year follow-up. Overall, 64% (95% CI, 57%-70%) of the patients were able to return to their same or higher level of play. Before surgery, 92% of the patients expected to return to their same preinjury level of Australian Rules football participation. At the 2- to 5-year follow-up, 61% who returned to play felt that they could perform as well as they could before their ACL injury. A greater psychological readiness to return to sport preoperatively and higher level of sport participation were significant predictors of a return at 2 to 5 years. Further ACL injuries were sustained by 21% of the cohort (15% graft rupture; 6% contralateral ACL injury). Conclusion: Most male athletes who participate in Australian Rules football returned to some level of play after ACL reconstruction; however, only 64% returned to preinjury levels. Preoperative expectations were not met, and high reinjury rates are a cause for concern.


The authors acknowledge the support of Timothy Whitehead and Cameron Norsworthy as part of the OrthoSport Victoria Research Program.


Publication Date



Orthopaedic Journal of Sports Medicine





Article Number

ARTN 23259671221074999




SAGE Publications



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© The Author(s) 2022. This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License ( licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at