Return to American Football after Anterior Cruciate Ligament Reconstruction

Introduction

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries encountered in sport today. These potentially devastating injuries occur in both contact and noncontact athletes, and can forever change the course of the affected athlete’s career. It is estimated that approximately 200,000 ACL tears occur annually in the United States, with a reported incidence in American football players of approximately 0.07 per 1000 exposures in high school and 0.11 per 1000 exposures in professional athletes, respectively. Despite the known long-term risk of osteoarthritis following ACL injury, the primary short-term outcome of concern for the majority of these athletes is return to sport-related activities. The reality of achieving that goal requires not only a well-directed prehabilitation program and a technically sound reconstruction, but more importantly an extensive rehabilitation program aimed not only at rehabilitating the involved lower extremity musculature but also identifying any pathologic dynamic loading patterns that need to be corrected to attempt to prevent reinjury. Even with each of these tenets executed to plan, however, a myriad of other factors are in play that can help or hinder the success of returning the American football athlete to sport.