Anterior cruciate ligament ruptures requiring surgical reconstruction are associated with decreased performance compared to matched controls in National Hockey League players

Abstract Purpose To evaluate National Hockey League (NHL) player productivity and effectiveness following anterior cruciate ligament (ACL) reconstruction using advanced hockey statistics. Methods NHL players who underwent ACL reconstruction between 2008 and 2022 were identified using the NHL Injury Viz database. Players with multiligament injuries, reruptures, players who had complications requiring revision surgery within the study period, players without pre‐ or postinjury performance data, goaltenders and players who sustained another orthopaedic injury requiring surgical management during the study period were excluded. Demographic and outcome data for 1‐year preinjury and 2‐year postinjury were abstracted. The primary outcome was wins above replacement per 60 min played (WAR/60). Secondary outcomes were offensive and defensive goals above replacement per 60 (GAR/60) min played. Controls were NHL players matched by position, draft year and index season performance. Pre‐ and postinjury outcomes were compared with paired t ‐tests for normally distributed variables and the Wilcoxon signed rank test for nonnormally distributed variables. Results Sixty‐one ACL ruptures were identified, of which 43 were eligible for inclusion. Preinjury, postinjury year 1 and postinjury year 2 WAR/60 were 0.05, 0.02 and 0.03 in cases ( p = 0.01, p = 0.03 compared to preinjury) and 0.04, 0.05 and 0.08 in controls ( p = 0.50, p = 0.00, p = 0.00 compared to cases). Preinjury, postinjury year 1 and postinjury year 2 offensive GAR/60 were 0.24, 0.13 and 0.18 in cases ( p = 0.04, p = 0.03 compared to preinjury) and 0.16, 0.27 and 0.37 in controls ( p = 0.83, p = 0.02, p = 0.01 compared to controls). Preinjury, postinjury year 1 and postinjury year 2 defensive GAR/60 were 0.04, −0.01 and 0.02 in cases ( p = 0.17, p = 0.39 compared to preinjury) and −0.03, 0.01 and 0.03 in controls ( p = 0.08, p = 0.60, p = 0.89 compared to controls). Conclusions ACL ruptures requiring surgical reconstruction are associated with significantly decreased performance in NHL players compared to preinjury and matched controls, driven by significantly decreased offensive performance. Level of Evidence Level III, therapeutic case‐control study.