No clear association between time to return‐to‐play and first additional injury in European professional football players after ACL injury: A media‐based study

Abstract Purpose The primary aim of this media‐based study was to investigate whether time from anterior cruciate ligament (ACL) injury to return to play (RTP) was associated with the hazard of a first additional injury over calendar time among male professional football players in the five major European leagues. Secondary aims were to examine associations with a first additional injury within 365 days after RTP and with the number of official competitive matches missed because of the first additional injury. Methods Male professional football players who sustained an ACL injury, underwent ACL reconstruction and returned to official competition were identified from publicly available data. RTP was defined as the first official competitive match after ACL injury. Cox proportional hazards regression assessed associations over the full follow‐up and within 365 days, adjusted for age and player position. Sensitivity analysis examined predefined RTP categories; negative binomial regression assessed the association between time to RTP and the number of official competitive matches missed because of the first additional injury. Results Among 278 players, mean time to RTP was 242.3 ± 99.5 days and 201 (72.3%) sustained a first additional injury. No clear evidence of an association was observed between time to RTP and the hazard of a first additional injury over the full follow‐up or within 365 days. Similarly, no clear evidence of an association was observed in the categorical sensitivity analysis or between time to RTP and the number of matches missed because of the first additional injury. Conclusions No clear evidence of an association was observed between time from ACL injury to RTP and the hazard of a first additional injury either over the full follow‐up period or within 365 days after RTP. Similarly, no clear evidence of an association was observed between time to RTP and the number of official competitive matches missed because of the first additional injury. Level of Evidence Level IV.