{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:45:37Z","timestamp":1791927937680,"version":"4.3.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sports Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Return to competition (RTC) after anterior cruciate ligament reconstruction (ACLR) is frequently reported, but long-term football participation following return remains poorly described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim was to describe RTC rates after primary ACLR in football players and to evaluate post-RTC career sustainability, quantified by the number of matches and seasons played, across sex, age, and pre-injury level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this decade-long nationwide cohort study, football players undergoing primary ACLR between 2014 and 2023 were identified in the Swedish Knee Ligament Registry and linked to the Swedish Football Association\u2019s match database. RTC was defined as participation in one or more official match after surgery. Analyses of post-RTC match and season participation were restricted to players who returned by the 2022 season or earlier, allowing a minimum potential follow-up of three seasons. Outcomes were compared across sex, age groups, and pre-injury level using non-parametric methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 10,836 football players were included, of whom 6339 (58.5%) achieved RTC. RTC rates varied across pre-injury competitive levels, ranging from 90.4% at the top level to 35.9% at the recreational level (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u202f0.001). Among players with sufficient follow-up (\n                      <jats:italic>n<\/jats:italic>\n                      = 4749), median post-RTC participation was 31 matches (interquartile range [IQR] 11\u201370) across three seasons (IQR 2\u20135). Men accumulated more matches after RTC than women (33 vs 29;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.017) and remained active for more seasons (4 vs 3;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Pre-injury competitive level was strongly associated with career sustainability (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u202f0.001): top-level players accumulated a median of 97 matches (IQR 42\u2013148) across five seasons (IQR 3\u20136), whereas players competing at lower levels accumulated fewer matches and seasons. Age-related differences were significant in men but not in women.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Football career sustainability following primary ACLR was greatest among players competing at higher pre-injury levels and, to a lesser extent, among men. Although RTC was commonly achieved, long-term participation after return was often limited, indicating that RTC alone provides an incomplete description of football participation after ACLR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40279-026-02558-6","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:58:32Z","timestamp":1791925112000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Return to Competition and Career Sustainability After Primary ACL Reconstruction in Football: A Nationwide Cohort Study of Long-Term Participation"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0124-5782","authenticated-orcid":false,"given":"Alexander","family":"Sandon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6871-3267","authenticated-orcid":false,"given":"Christoffer","family":"von Essen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9162-4948","authenticated-orcid":false,"given":"Abdulaziz","family":"Farooq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5870-7477","authenticated-orcid":false,"given":"Magnus","family":"Forssblad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"1","key":"2558_CR1","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/bjsports-2020-102200","volume":"55","author":"TA Diermeier","year":"2021","unstructured":"Diermeier TA, Rothrauff BB, Engebretsen L, Lynch A, Svantesson E, Hamrin Senorski EA, et al. 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Restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data may be available from the corresponding author upon reasonable request and with permission from the relevant data custodians.","order":2,"name":"Ethics","label":"Availability of data and material","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"AS conceived and designed the study, contributed to the statistical analyses, interpreted the data, and drafted the manuscript. AF performed the statistical analyses and contributed to data interpretation. CvE critically revised the manuscript for important intellectual content. MF supervised the study and contributed to study design and manuscript revision. All authors approved the final version of the manuscript for submission and agree to be accountable for all aspects of the work.","order":3,"name":"Ethics","label":"Authors\u2019 contributions","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Swedish Ethical Review Authority (Dnr 2024\u201306108-01) and was performed in accordance with the ethical standards of the Declaration of Helsinki.","order":4,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was not required for this study in accordance with Swedish regulations governing registry-based research using de-identified data.","order":5,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":6,"name":"Ethics","label":"Code availability","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":7,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}