High return to competition rate following on-field rehabilitation in competitive male soccer players after ACL reconstruction: GPS tracking in 100 consecutive cases

Background: Despite published guidelines describing on-field rehabilitation (OFR) frameworks for soccer, available evidence for practitioners who work with players with anterior cruciate ligament reconstruction (ACLR) is limited. Purpose: To document the activity and workloads completed by a large cohort of amateur and professional soccer players during OFR following ACLR after completing their indoor rehabilitation and to establish their return to competition (RTC) outcomes. Study Design: Case series; Level of evidence, 4. Methods: OFR measurements/activities, global positioning system (GPS), and heart rate data were collected from 100 male 11-a-side soccer players with ACLR undergoing a criteria-based rehabilitation process, concluding with a 5-stage OFR program. Consent was obtained directly from the players involved in this study before completing a follow-up questionnaire to document RTC outcomes. Differences between the level of play (professional and amateur) and 5 OFR stages were investigated using separate linear mixed models. Results: A minimum 9-month follow-up was possible for 97 players (97%), with a median time of 2.3 years after ACLR and 84% RTC, with higher rates in professionals (100%) than amateurs (80%). Ten (10%) players sustained an ACL reinjury. Professionals completed more OFR sessions (20.6 ± 7.7 vs 13.2 ± 7.7; P <.001) over a shorter period (44.7 ± 30.3 vs 59.3 ± 28.5 days; P =.044) and achieved higher workloads mostly in the high-intensity GPS metrics in each OFR stage. Typical external workload outputs in the final OFR stage aligned with team training demands for the total distance (TD) (106%), high-intensity distance (HID) (104%), peak speed (PS) (88%), acceleration distance (ACC) (110%), and deceleration distance (DEC) (48%), but they were lower compared with match play demands (TD: 44%; HID: 51%; PS: 82%; ACC: 63%; and DEC: 26%). Conclusion: High RTC rates were reported in those players who participated in OFR after indoor rehabilitation. Completion of all five OFR stages almost prepared them for team training demands; however, workloads remain low compared to match play.