Objectives: A media-based collection and further analysis of relative return to play (RTP) rates and the corresponding quality of play after anterior cruciate ligament (ACL) rupture in top level football was the aim of our study. Methods: In the 5-year case-control study, male players from the first two leagues of the five European countries top leagues, who sustained a total ACL rupture during the season 2010/11 and/or 2011/12, were included. For them and a matched control sample (ratio 1:2), data were retrieved from the publicly available and validated media-based platforms (transfermarkt.de & whoscored. com) until the end of season 2016/17. Injury and return to play-specific data were calculated as rate ratios (RR) to compare the injured and matched control athletes rates and as a survival analysis (log-rank-test; career duration). Results: Overall, 132 ACL-injuries in 125 players occurred. The RTP rate was 98.2%, the RTP to same level was 59.4%. Five years post RTP, 69.9% of the ACL group were still engaged in football (RR = 87%), 40.9% at the same level (RR = 72%). Survival analysis revealed a systematic group difference in career duration compared to controls (Cox-Mantel's Chi² =5.8; p= .016). Game performance (scoring points, p < .001; rates/number of completed passes, p = .048; and minutes played, p < .001) was lower in the ACL athletes than in the matching group in the RTP and post RTP seasons. Conclusion: Although absolute and relative RTP rates after ACL reconstruction are high in professional football, career duration and performance quality are lower than in the reference group.
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