Is return to soccer likely after ACL surgery?

We hear about ACL injuries all the time in professional sports. Robert Griffin III and Derrick Rose immediately come to mind. We don’t think of them as common soccer injuries as often – at least not in the United States. Anyone who plays soccer or has high school or college children who play, though, is surely aware of these injuries.

Knee injury in soccerAnterior cruciate ligament tears are among the most common and severe injuries of the lower extremity in soccer. A study of elite European soccer shows that a professional team can expect 0.4 ACL injuries among its players per season, or just under one player on the team going down every two years. And ACL tears are even more common among female athletes. I remember one girls’ soccer team in the Charleston area losing five players to ACL tears in one season.

Fortunately ACL reconstruction will help these players regain stable knees. In fact, in the past, orthopaedic surgeons have often quoted success rates of 90% or higher with these surgeries. So soccer players are pretty much guaranteed to return to soccer, right?

Maybe not. A study in the November 2012 issue of the American Journal of Sports Medicine examines the rates of return to play after ACL reconstruction. Specifically they look at soccer players and identify risk factors that could indicate risks for reinjury or never playing soccer after the injury at all.

Robert H Brophy, M.D. et al contacted soccer players included in the Multicenter Orthopaedic Outcomes Network (MOON) Group. This is a database of patients who have undergone ACL reconstruction by surgeons at centers across the country. They found that only 72% of soccer players returned to play soccer after ACL surgery.

This study had a number of other interesting findings as well:

    Of the athletes who do make it back to soccer, return occurred at an average of 12.2 months after surgery.

    85% of players who did return eventually got back to the same or higher level of soccer.

    Male soccer players were more likely to return to play than female athletes.

    Younger soccer players were more likely to return to play than older ones.

    12% of soccer players underwent a second ACL surgery. 75% of the second ACL procedures were performed on the athlete’s opposite, or contralateral, knee.

    Female soccer players were more likely to require a subsequent ACL surgery.

    Athletes who tore their nondominant leg’s ACL in the first injury were much more likely than those who injured their dominant leg to require ACL reconstruction of the contralateral leg in the future.

What can soccer players and fans learn from this study?

First, the finding that only 72% of soccer players make a successful return to play is lower than I think most orthopaedic surgeons and soccer players would like to see. This data does corroborate the findings of the study looking at return to sports among college football players who underwent ACL reconstruction, though.

ACL rehab
A soccer player working to regain balance, proprioception, and plyometric strength before returning to play
Also, younger and male soccer players are more likely to return to play. The ACL injuries and surgeries themselves might serve as the main barrier to return to soccer, but other factors like graduation from school, loss of desire to play, and more might play a role. Even fear of reinjury could keep athletes from returning to soccer. Regardless, the lower success among females seems surprising, at least to me.

Finally, we have discussed the importance of ACL injury prevention programs in the past. This study shows a high recurrence rate, especially in females and for injuries of the nondominant leg. Any soccer player who undergoes ACL reconstruction should consider learning and regularly performing the exercises of one of the injury prevention programs to decrease the chance of reinjury of the graft or opposite knee’s ACL.

What do you think? Do these findings surprise you? Are you a soccer player who never returned to soccer after surgery? Do you treat soccer injuries and have advice or thoughts? Share your ideas below!

References:
Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, McCarty EC, Spindler KP. Return to Play and Future ACL Injury Risk After ACL Reconstruction in Soccer Athletes From the Multicenter Orthopaedic Outcomes Network (MOON) Group. Am J Sports Med. 2012;40:2517-22.

Walden M, Hagglund M, Magnusson H, Ekstrand J. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc. 2011;19:11-19.

65 Responses to Is return to soccer likely after ACL surgery?

  1. Hello I just recently had surgery on my ACL last Friday. I play soccer an I want to know about this because I have so much going through my head about all this. I really do want to return to playing soccer because it is my passion but after going through this I am scared of the possibility of getting re injured I’m only 20 years old.

    • Great question! I might use it as one on my podcast soon, as it requires a longer answer than I can write here. In general, the twisting and cutting motions involved with quickly changing directions and stability required for landing makes soccer nearly impossible without a functioning ACL. Surgical reconstruction of the ACL tear is almost always required for a soccer player to return to play. Re-injury can occur, but a good surgical procedure and agressive physical therapy and functional training minimize those injuries as much as possible.

  2. Thanks for these articles! I actually just underwent my second ACL surgery (same dominant knee) in September 2012. I was told by a trainer to build more muscle on my legs in order to prevent another injury. Is that true? Any suggestions? I am a female and have every intention on going back this outdoor season.

    • Generally athletes should regain full quadriceps and hamstring strength prior to return to sports, which can help prevent injury to that knee or the opposite one. Plus it helps with sports and exercise performance. Glad the articles were helpful!

  3. So question I had ACL surgery last April 19th and it hasn’t been a year yet since then I have had a second surgery on March 21st, 2013 for fatty pad, scar tissue, and a Cyclops lesion. It will be 2 weeks tomorrow since I had the surgery and I fell going down my steps and my knee looks twice as swollen and I don’t know how badly I injuried it. Im only 17 years old and I did it during soccer and have yet to return to any type of sports. Well I want to play in the fall but I kinda nerves of reinjuring it and I don’t know what I should do. Any advice or comments would be great!

    • Natalie, thanks for the question. I really cannot give you a specific answer to your question, as I haven’t seen you as a patient or examined you or seen any radiographic studies. I would check with your surgeon. Generally if a patient regains full motion, strength, and functional ability after ACL reconstruction, he or she can return to play, even soccer. A cyclops lesion and scar tissue in the knee could hinder that ability, but I cannot say in your case.

  4. just a few day back i had torn my ACL while playing football and the MRI shows that it is near to torn with some fiber still intact are their chance of self healing or should i opt for surgery

    • In high-grade partial ACL tears, the actual ligament fibers do not heal. If the knee is unstable, I usually recommend surgery. I cannot say specifically in your case what you should do, but your surgeon can assess the stability of your knee.

  5. I just had ACL reconstruction on March 4th of this year, I am a 15 year old female in high school and I injured my ACL during soccer. My physical therapist told me I am about a month ahead in rehab according to my protocol from my surgeon. I also play volleyball and season starts at the beginning of August, I was just wondering if you had any advice on whether I should get back into volleyball right away if I am cleared or if I shoul keep strengthening my leg for soccer season next year in March!

    • I don’t know that there is a right answer for all athletes. I think it is always a good idea for an athlete to get her knee as close as possible to 100% prior to return to sports. If there is a question of returning to early to a sport, then it can be a good idea to stay and, keep working with the physical therapist, and return either later that season or return for the next one. If one sport or season is more important than another, then I think that factor can help the decision-making process as well.

  6. Thanks for the article Dr. David Geier!

    I completely tore my ACL about 9 weeks ago (confirmed by an ACL). I’m in my early 20′s, super active (play sports like soccer, ultimate, basketball) at least 3 times a week. From early research on the topic, I was certain that I would need surgery to get back to my active lifestyle, however, currently on the waitlist, I have been doing more research and came about more findings on ACL Copers, and athletes who may not need a reconstruction to return to play at their previous level.

    I was wondering what your thoughts are on this?

    My knee appears super stable, no incidences of giving way, I can run up and down the stairs no problem (haven’t tested it on the field yet though… nor have I tried doing jumping). My muscles have atrophied dramatically the first couple weeks after injury but I’d say I’ve regained it to about 70% of my other quad. Have been going to the gym/pool everyday.

    Just recently, my physio has been noticing an “endpoint” when doing the Lachmann test… I have read about an ACL being able to scar back to the PCL and in rare occasions even completely heal after being torn.

    I have always been a fan of healing the “natural” way, but if surgery means that I will be able to play hard for another 30 years, I’ll be more than willing to take it on. However, if it’s not needed, I wouldn’t need to risk the possible complications of surgery.

    Do you have any suggestions as how I should proceed? Have you dealt with athletes who are able to perform pre-injury level without ACLr?

    Let me know when you get the chance.

    Any help would be appreciated. Thanks in advance!!

    • Unfortunately I cannot give you specific advice. If an athlete has a stable knee without surgery and does not feel the knee give way with cutting or pivoting maneuvers or landing from jumps, it might be possible to avoid surgery. In my experience, most active people do not ultimately have stable knees.

  7. I am a 2o year old male I just had a injury three month ago and there were evidence of ACL tear but my doctor says that I don’t need surgery if I don’t wanna play soccer professionally but I have just get heal that I can walk slowly,Do you think that I needed a surgery? Do you think in this case I can play soccer again?

    • I think that it can be very difficult to play soccer even at a recreational level or do other activities that involve cutting or pivoting without a functional ACL. I cannot tell if you would be able to without being involved in your care, though.

  8. Hi,my daughter is 13 yrs old and tore her ACL 1 year ago as well as a latteral meniscal tear..she is 5 ft 11 inches and she also has Genuvalgum …she had surgery and completed 6 months of therapy to only have another surgery again on her meniscus as it tore more during therapy.she has just completed another 6 months of therapy and is dying to get back to soccer..it is her passion and she an AMAZING goalie:)…of course i am worried sick and tryouts are this week..Her therpist and surgeon say as long as she is conditioned ,and she is, to go for it!! (her dream is to be in the Olympics and play for the USA team:))…whats the chance of her reinjuring the meniscus and acl? Thank you for your time! ~Alexis

    • I can’t really give you any specific predictions without being involved in her case. Generally we have ACL reinjury rates between 3 and 5% in the first year. Interesting to many is the fact that the rates of ACL injury in the opposite knee are actually a little higher in that first year.

  9. Hi Dr. Geier,

    Great article and tips. I’m post op about 10 weeks now on my right ACL/PCL and was wondering about the numbness on the front of the right leg that was operated on. My graft came from my hamstring. Will the numbness last pretty much forever and are there ways you would suggest to activate the sensation in the affected areas?

    Thanks much

    Chris

    • Numbness from cutting the microscopic skin nerves around the harvest incision site is very common after ACL surgery. It is hard to avoid due to the nature of the nerve locations around the knee. It tends to persist forever although it often gets smaller over time. Most patients don’t notice it other than females when they shave over the area.

  10. doctor my name is armando. I tore my acl back in december to have it diagnosed on january and had surgery march 1st of this year. Ortho said that my acl ripped off and healed to my pcl plus i had no signs of an unstable knee if felt normal until i tried playing once more and when pivoting and changing direction on a play my knee gave away so i opted for surgery. it has now been almost 4 months since my surgery and my knee feels awesome at times i even forget i had surgery. Doctor said my progress has been impresive even after i had no pt did everything on my own at home. i have full range of motion and my strength is about 80% to what it was before. i do get a bit scared because i feel my knee incredible and sometimes think something happened to my graft but doctor says its ok. i was wondering can your graft rip off with everyday regular activities as walking just hanging around or is it very secure? another thing is that is your graft weaker than the original acl or can it resist as much presasure as the original?
    thanks for taking the time on replying to this post it is very important to me

    • Typically when the graft has fully incorporated, it is as strong or stronger than the native ACL. Regaining full strength of the lower extremity is important to minimize the risk of tearing the graft. If all goes well, the graft should not be at risk during activities of daily living. If there are specific concerns about your graft, though, I would check with your surgeon.

  11. Hi Dr.Geier, I am a 16 yr old female that is about 48 weeks postop. I had patellar tendon autograft used, with some meniscus repair. At this point, I feel as though my knee is about 95% to where it was before. I returned to soccer at 7 months post op, and have progressed to playing comfortably. Although I still play on the same on the same team, I am not as good of a player as I was before. Whenever I ask my coach on what I can do to improve, he says that my health and my knee will not be at 100% until 2 years postop. Are there any doctors that believe that the full recovery time is this long?

    • I think most sports medicine surgeons feel that 12 months is a usual time for athletes to return to feeling like their knees are back to normal. It does seem that many athletes feel that it is their second season back before they feel comfortable on it and don’t think about the injury and the knee.

  12. Hello Dr. Geier. Great articles and information. My 15 y/o daughter had surgery on her acl and meniscus in Feb. after an injury during a soccer game. She was recently cleared to full practice and play. She wearing a Donjoy brace for play and practice. I have two questions:

    1. You refer to specific warm-up exercises that may help prevent injury. Do you have these listed somewhere? My daughter does seem to do some warm-ups specific to her, but I would like to see if there is more she should be doing to help prevent another injury.

    2. The Donjoy brace does somewhat limit her speed. But she is getting faster as she is getting used to the brace. Is it realistic to expect she will get back to full speed while wearing the brace? She was told to wear it for 6-12 months.

    She has had a very remarkable recovery, and feels great. She is being eased back into game play, which is the smart thing to do. But she can’t stand it! She wants to play the full game as she did previously.

    Thank you again for the site.

    • I don’t have these exercises in a format that they can be distributed online. I think they need to be done under the supervision of an athletic trainer or physical therapist. I wrote a column about it that you might read.
      http://www.drdavidgeier.com/ask-dr-geier-online-acl-injury-prevention-programs/

      As for a custom ACL brace, I don’t typically require athletes to wear them after primary surgeries, but some surgeons do. You might ask her surgeon about risks and benefits of playing without it based on her surgery and rehab. I hope that helps!

  13. At this moment I am on day 68 after a complete tear of my ACL, with partial tear of miniscus, mcl. Knee was practically locked for the first few weeks, but then a violent pop allowed me to regain mobility. Extreme physio has followed, but very specific, very proper regime. Looking extremely likely that surgery will not be needed. Feeling like I can already return to the game, but we have a few more things to focus on.

    My biggest issue, with so so many articles on this topic, is the failure to mention pre-surgery physio. After surgery you will drop significantly (atrophy speaking). With physio before surgery, you will drop less and have a head start to recover.

    From my own experience, and from stories from my physio people (who deal with professional athletes), a year after surgery (and/or a year after injury) should be a thing of the past if the process is done properly.

    Why is there not more education towards pre-surgery physio???

    • I am a bigger fan of preoperative physical therapy before ACL surgery for many reasons. I actually have a blog post about the idea coming in the next few weeks. Thanks!

  14. I have today finally found out that I have completely torn my ACL and damaged my meniscus after sustaining the injury 2 months ago.it is my non dominant leg (left) the consultant also told me I had fractured my shinbone at the top of the joint but this was insignificant?! I play football (soccer) And he has told me I can’t play again after the acl reconstruction . I’m 24 and the way I play relies on my speed agility. would I stand a better chance of returning to the game if I played in a different position? I’ve never had any other major injury so I’m finding it difficult to accept that I just cant play again.

    • Generally return to sports rates can be good for athletes after ACL surgery, but it can take quite a bit of time and work, often 12 months or more. The goal whenever we do ACL surgeries is to allow patients to return to their desired sports or activities. There can be some variations depending on factors specific to each patient, though.

  15. Thanks for your response. Could you tell me, would you treat a patient differently if your only goal was to stabilise the knee rather than to help the patient return to their sport? Would the surgical approach be different?

  16. Hello Doctor, I’ve had this concern for the past two years. I’m currently 20 years old, back when I was 17 I had a knee injury (lateral meniscus & medial meniscus tear) on my dominant leg. A month from the injury I had surgery, after two months of therapy treatment I was able to play soccer that year (I felt physically well, as well as mentally). A year later, I suffered a second injury but this time on my opposite knee. My doctor has approved that it is the same injury as my last one, but unfortunately due to financial issues it’s until this following year that I will undergo surgery. My question is, is it safe for me to go back to play collegiate soccer Division III? All my life, soccer has been my passion and I’ve had many opportunities to play at a pro level, but due to the injuries that has not been possible.

    • I really cannot give you a specific answer to your question, as I haven’t seen you as a patient or examined you or seen any radiographic studies. Generally an ACL-deficient knee can be unstable. An athlete with a knee that buckles or gives way with jumping and landing or cutting and pivoting can do damage to the meniscus and articular cartilage. Some athletes do well in an ACL brace and can play without surgery, but frequently athletes need surgery.

  17. This article (plus the references) was exactly what i was looking for.I reconstructed my non-dominant knee in 2007, when I was 21.After 12+ months and a big fluctuation in my weight (another factor that must not be ignored in my opinion),I returned, and I was better than before.Having “the fear” at first,made me better tactically and technically.Unfortunately, two months ago,while being 26 and in my best physical condition ever, I tore the contralateral ACL.I will undergo surgery again because I am still very active but to be honest I don’t know if I ll try to return again, at least not at the same level.The reason is that 1. The surgery and the Physiotherapy following costs a lot! 2.It took me a lot of time to recover then, but in the future I won’t have the option for a third injury (with my job, lack of free time etc.)

  18. My daughter is 13 years old and very very active. She plays soccer, basketball and softball all at a highly competitive rate. She is a very fast runner. She hurt her knee doing a jump stop in basketball as another girl slammed in to her. She was helped off the court and then wanted to go back in a while later I told her no. We couldn’t get an appointment for 3 weeks to see an Orthopedic. In the mean time she has been able to walk and run but the knee would buckle when twisting. She is very athlete and determined her knee hasn’t really been bothering her. I finally got her to the doctor and they did an MRI. The doctor called me back yesterday and said she has a total tear of her ACL, a Medial meniscus tear and a sprained mcl.
    My questions are will she ever be as fast as she was? her dream is to play professional soccer or softball will she still be able to do this? she is only in 8th grade and has had many people already looking at her. She starts high school in 5-6 months and wants to be ready for soccer is this possible? Sports is her life and without them she would be totally devastated will she be able to continue at the same rate she has been after the surgery?

    • Return to sports rates are good after ACL reconstruction surgery. Return to play is more likely than if an athlete doesn’t have surgery. It is a long, difficult process, though. It takes many athletes 12 months or more to return to the same level of play.

  19. Hello drdavidgeier,

    I’m a college soccer player and I torn my dominant side ACL. I’m 4 months out of surgery. I had a patella tendon graft. Rehab has been going great. Looking ahead,I pretend to play next fall if I’m healthy. For soccer players, what are the best options for knee braces coming back to sport? My doctor recommended DonJon, but i tried on and it feels extremely unconfortable.

    Please let me know what your thoughts are!

    thank you

    • I don’t know that I have a strong impression. I don’t make athletes wear a custom ACL brace after ACL surgery unless they feel better in them or need one for a small number of reasons. I think the custom braces are more comfortable and protective, so I usually recommend one if the patient and I decide to go that route.

  20. I had ACL surgery a year and a half ago, I’ve been back to playing soccer for about a year now. My surgeon said I’d need to wear my knee brace for a year after my surgery. Do you think it would be an okay idea to stop wearing it while I play? I’m afraid of tearing it again, but I feel like I’m a much better player with out it. Please help!

    • I can’t tell you what to do since I am not involved in your care. Generally if an ACL surgery is performed well and the patient regains strength, motion, balance and all functional abilities, a custom ACL brace is not necessary for sports.

  21. Injured my acl about 6months ago playing football (soccer) I’ve had an MRI done and there is a problem with my acl but my surgeon just said there’s a problem and that he did not see a tear. I received physio for 3 months at the start of my injury and was told I could return to the pitch to play, in the warm up I felt a crunch and hit the floor, I’ve not had an operation done as the surgeon says my knee is stable and it’s probably a confidence issue and that I was to get a second opinion. I need to play again but feel like I’ve been left chasing my tail not knowing what to do. I can sprint, jog, run and jump but Ive not tried pivoting quickly and this is what could hold me back. Your advice would be much appreciated

    • Unfortunately I can’t say too much without examining you and looking at your studies. The problem with an ACL-deficient knee is a lack of stability with landing and rotational movements. It is important to know if an ACL is providing stability to the knee if there is a partial tear or other degree of injury.

  22. I’ve just torn my acl on Sunday after 10 minutes playing our local rivals, the goalkeeper wiped me out, half going for me and half for the ball I think. I’m 33, been playing since I was 8, the doctor has put me I a full leg cast until the swelling goes down and he can operate. What would you give my chances of playing again? After looking at the MRI results, doctors reaction wasn’t good. @ Ross, hope you get sorted out lad.

    • I don’t know that I can say any more specifically in your case. Generally rates of return to sports at the same level after ACL reconstruction at 12 months fall between about 50% and 85% in most studies.

  23. Very informative blog post!! I’m currently recovery from my ACL reconstruction and I’m wondering, how do I know if my knee is ready to return to sports? Thanks in advance!

  24. Hi Doc,

    In 2012 (june) I tore my ACL, MCL and PCL in my right knee, when I was 16 recon in July. Currently 2014 I have returned to running, and have started training in football (soccer) again. But I feel as if my knee isn’t the same, and therefore I feel as if I cant fully do what I was capable of beforehand. Is this because I haven’t been doing the certain activities for such a long time? And will this get better with time, I still feel that it is more psychological and me not wanting to get injured again, will this go away with time?

    Thanks

    • Return to sports after a multi-ligament knee injury can be very difficult. Fear of reinjury, like we see in ACL injuries, can be part of it. Also it seems to be harder for a patient to regain full motion, strength and function. Working for as long as necessary with a sports physical therapist can be helpful in overcoming those factors.

  25. Dear sir my son is 18 y. Old had acl r 9 months now he had a flexion limitation that is improving he is asking to go to play football on recreational level he is afraid of reinjury. As well me I am asking if there are objective criteria to base a decision of returns to play advice, so we can avoid re injury he is still doing his physeo classes. Thank you in advance

    • I’d ask his orthopaedic surgeon and physical therapist. There are many factors that guide the return to play decision.

  26. hi, im a 16 year old soccer player. I’m injured with a torn ACL. is it true that i can do physio and play soccer without repairing my ACL before I’m 18? then when I’m 18 id have to do the surgery? or is that just nonsense?

    • If a patient has no giving way or buckling of the knee despite a torn ACL, in theory he can return to sports. Most active people have instability of the knee with sports that require cutting or pivoting, so they end up undergoing surgery to avoid further damage to the knee.

  27. Hi,

    I’m 30 year old healthy male, been playing soccer all my life. I have my ACL reconstruction in August 13, so 9 months ago. I’ve not played soccer since, but want to play at the weekend in a casual game with my mates. Do you think 9 months is enough time? I only want to play for 5 minutes. my operated leg is not the same as my good leg yet, and still a bit smaller in muscle mass.
    Thanks, Paul

    • Paul, I can’t say when an appropriate time for return to sports is specifically for you since I am not involved in your care. Generally we like patients to have full strength, motion, and functional ability back in the involved lower extremity. Your orthopaedic surgeon can advise you about return to play.

  28. My daughter had ACL reconstruction, returned to play at 6 months and tore it again. She is now 1 year post-op from the second surgery and has just started to play again. Not surprisingly, she is fearful of re-injury and every ache and pop scares her. My question is this…how much pain is normal as you get back into playing a pivot sport again (soccer, in her case)? Are little pops normal (scar tissue)? Swelling? She did PT, Sports Performance Training with PT, and then track prior to returning to soccer so she’s in good shape.

    • Usually athletes don’t have much pain or swelling once they are ready to return, although fear of reinjury is not uncommon, as you mentioned.

  29. hi I am 32 years old I fully ruptured my acl last august. I have had to wait a year for my operation which is in September. will I play football (soccer) again? it is my passion and I hate to to think that is it!what do u think?

    • I can’t predict your outcome, but I would ask your orthopaedic surgeon. Generally studies have shown that 2/3 or more of patients who undergo ACL reconstruction return to sports within 12 months.

  30. hello doc…i have undergone a ACL reconstruction surgery but due to late operation i have ham my lateral meniscus damaged and it was dislocated at the time of injury….and the lateral miniscus was removed during the operation ….my question is can you kindly give your suggestion wether i will be safe to play soccer ??

    • Return to sports is more a question of regaining full motion, strength, stability and function. The question after a meniscectomy is the development of long-term degenerative changes.

  31. Hi.. Firstly your articles are great, seeing the facts actually gives some confidence that my knees may get back to normal. I just wanted to hear your thoughts on cracking and popping in the knees. I’ve had both knees operated on, non dominant first and a year later the dominant one. My dominant knee feels far stronger than the other at this stage than the other did. The one thing I’ve noticed is a feeling of looseness in the knee when turning but without instability and the odd cracking or popping feeling in the joint. I was wondering if you’ve heard of this and if it’s a problem that needs addressing?

    • I can’t say specifically in your case, but popping or cracking can be common in knees after surgery without significant issues causing them. Also, if there is some wear of the articular cartilage underneath the patella, it can cause those symptoms as well. Good luck!

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