September 24, 2017
1 min read

Survival rate after ACL reconstruction varies among sports

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Athletes in the National Football League experienced the lowest survival rate after ACL reconstruction, while athletes in the National Hockey League had the highest survival rates and highest rates of return to play, according to recently published data.

Wellington K. Hsu

Wellington K. Hsu, MD, and colleagues collected sport-specific performance statistics before and after primary ACL reconstruction from 344 athletes in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL) and Major League Baseball (MLB). They defined return to play as a successful return to the active roster for at least one regular season game after ACL reconstruction.

Results showed 86.6% of all athletes return to play after ACL reconstruction, with a significantly higher return to play rate and a significantly shorter time to recover from surgery and return to a regular-season game among NHL athletes. Researchers found NFL athletes had significantly shorter careers following ACL reconstruction while NBA and NHL athletes had significantly longer careers.

Kaplan-Meier analysis showed a significant decrease on active rosters two seasons and three seasons postoperatively among NFL athletes compared with other sports. Conversely, researchers found a significantly increased survivorship among NHL athletes. During postoperative season one, athletes of all sports played significantly fewer games, with a significant decrease in performance found in NBA and NFL athletes, according to results. By postoperative season two and season three, MLB and NFL athletes returned to preinjury levels of game participation and NBA and NHL athletes continued to participate in significantly fewer games.  

According to Hsu, these results suggest researchers should scientifically review the outcomes for all athletes after common injuries such as ACL reconstruction and not just high-profile athletes.

“Recent study success stories have led the lay public to believe that after ACL surgery, professional athletes can be expected to perform at higher levels than before,” he told “However, when the body of evidence is scrutinized, it turns out that NFL athletes in particular do not generally match the same performance as preoperative.” – by Casey Tingle


Disclosures: Hsu reports he is a consultant for Stryker, Bacterin, Graftys, Globus, AO North America, SI-BONE, Relievant Medsystems, CeramTec, Medtronic Sofamor Danek, Pioneer, Bioventus, LifeNet and RTI; receives trips/travel from AO North America; receives research support from Medtronic; and receives royalties from Stryker. Please see the full study for a list of all other authors’ relevant financial disclosures.