Impact of Anterior Cruciate Ligament Reconstruction on NCAA FBS Football Players: Return to Play and Performance Vary by Position

Background: Anterior cruciate ligament (ACL) injuries are devastating for college football players. Although the change in functional performance of National Collegiate Athletic Association (NCAA) football players after reconstruction has been shown to be negligible, studies have failed to analyze the statistical performance of these players upon their return. Purpose/Hypothesis: The purpose of this study was to quantify the impact of ACL reconstruction on the statistical performance of collegiate football players. We hypothesized that statistical performance would vary by position and that running backs, wide receivers, and defensive backs, compared with preinjury and controls, would experience the largest decline in performance after returning from ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: NCAA Football Bowl Subdivision (FBS) football players who experienced ACL tears between the years 2010 and 2015 were identified. The rates of return to play after surgery were determined for each position. Preinjury and postoperative performance statistics of each running back, receiver, defensive lineman, linebacker, and defensive back who met inclusion criteria were compared. A t-test analysis was used to compare the performance changes experienced by these players versus the performance changes of matched controls. Results: A total of 349 players were identified. Only 63.64% of eligible offensive linemen returned to play. Upon return, running backs experienced significant performance decreases compared with controls in carries (mean +/- SD, -2.4 +/- 2.7 vs 2.8 +/- 1.6; P = .003), yards (-12.3 +/- 15.5 vs 13.8 +/- 7.8; P = .006), and receptions (-0.22 +/- 0.32 vs 0.32 +/- 0.23; P = .011) per game. Receivers displayed significant performance decreases compared with controls in number of touchdowns (-0.019 +/- 0.110 vs 0.18 +/- 0.06; P = .004), receptions (-0.11 +/- 0.79 vs 1.2 +/- 0.4; P = .004), and yards (-3.2 +/- 10.6 vs 18.6 +/- 5.4; P = .0009) per game. Linebackers demonstrated less improvement than controls in tackles for loss (0.007 +/- 0.115 vs 0.31 +/- 0.11; P = .0003) and sacks (0.001 +/- 0.061 vs 0.10 +/- 0.06; P = .026). Conclusion: Although offensive linemen were the least likely to return to play, running backs and receivers returned to play at a lower level of performance. The performance of defensive players was less affected by ACL reconstruction.