Rates and Determinants of Return to Play after Anterior Cruciate Ligament Reconstruction in Division I College Women Soccer Athletes: A Study of the Southeastern Conference

Objectives: We sought to determine the overall return to play (RTP) rate of female collegiate soccer athletes after anterior cruciate ligament (ACL) reconstruction in the Southeastern Conference (SEC). Additionally, we examined particular athlete related and surgical technique related variables as they correlated to RTP. We hypothesized that RTP after ACL reconstruction would be higher than previously published results and that it would be independent of graft type utilization or surgical techniques employed. Methods: Head team physicians and athletic training staff of the 14 institutions of the SEC were contacted to request participation in the study. All institutions were sent information regarding the nature of the study, a standardized spreadsheet with standardized response choices for the purpose of data collection from the participating institutions, and instructions regarding athlete inclusion criteria. The spreadsheet provided queried certain athlete and technical surgical related variables for ACL reconstructions performed at the participating institutions over the previous 8 years (2005-2013). Results: All 14 of the SEC institutions chose to participate and provided data. 79 reconstructions were reported with RTP data available for 78 women soccer athletes. Overall RTP rate was 84.6%. There was statistical significance in RTP rates favoring athletes in earlier years of eligibility versus later years (p<0.05). Athletes in eligibility years 4 and 5 combined had a RTP rate of 40%. Scholarship status likewise showed statistical significance (p<0.001) favoring RTP rate for scholarship athletes (91%) vs. non-scholarship athletes (45.5%). Athlete position (p=0.242) and depth chart status (p=0.110) showed no significant effect on RTP. In examining surgery specific variables; RTP rate for autograft (87.9%), allograft (75%), and combined graft (50%) demonstrated no difference (p=0.218). RTP rates were similar for the two most commonly used grafts: patellar tendon autograft and hamstring autograft (p=0.186). Femoral tunnel drilling technique showed no effect (p=0.725) on RTP rate for transtibial, accessory medial portal, or two incision techniques. When comparing multiple graft fixation constructs on both the femoral and tibial side, no difference was observed as it relates to RTP. RTP in isolated ACL reconstruction (77.3%) versus ACL reconstruction with concomitant procedures (88.9%) showed no difference. For players undergoing revision ACL reconstruction versus primary, RTP rate was 77.3% and 87.3% respectively, without significant difference (p=0.499). Conclusion: Of Division I collegiate women soccer athletes undergoing ACL reconstruction, overall RTP rate approaches 85%. Undergoing ACL reconstruction earlier in the college career before the 4th year of eligibility as well as the presence of a scholarship had a positive effect on RTP. Surgical factors including graft type, fixation methods, tunnel placement technique, concomitant knee surgery, and revision status played showed no significant effect on RTP rate.