Impact of Pre-Elite Anterior Cruciate Ligament (ACL) Reconstruction on Draft Outcomes and Reinjury Risk in Elite Australian Football Players: A Retrospective Cohort Study

A history of anterior cruciate ligament reconstruction (ACLR) during the Australian Football (AF) talent pathway may impact draft prospects and increase the risk of a second injury during a professional career. This study investigated whether a history of ACLR before the Australian Football League (AFL) Draft Combine influenced draft outcomes and second ACL injury rates during an AFL career. A retrospective cohort study was undertaken, whereby AFL talent pathway medical evaluation data from 1071 male players who attended the AFL National Draft Combine between 2011 and 2022 was analyzed. Draft outcomes and secondary ACL injuries were compared between players with and without a pre-draft ACLR using chi-square and Fisher's exact tests. Twenty-one players (2.0%) had sustained a pre-draft ACLR. All of these players were drafted into the AFL. Players with a prior ACLR were more likely to be drafted in the first two rounds (odds ratio [OR] 2.64; <i>p</i> = 0.039). They were also over eight times more likely to sustain another ACL injury during their careers (28.6% vs. 4.5%; OR 8.54; <i>p</i> < 0.001). This study showed that a pre-draft ACLR did not reduce the likelihood of being drafted but was associated with a higher risk of a secondary ACL injury during an AFL career. These findings are relevant to AFL recruiters, medical staff, and high-performance staff, and support the consideration of education and injury prevention programs for pre-elite players with prior ACLR.