ACL Reconstruction for Combined ACL/MCL Injuries in Professional Soccer and Rugby Players: No Difference in Career Longevity Compared to Uninjured Matched Controls

BACKGROUND: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common in professional sport, but there is little evidence available regarding the long-term impact of them on players' sporting careers. PURPOSE: To determine the effect on return to play (RTP), career longevity, and match participation of male professional soccer and rugby players after primary ACL reconstruction (ACLR) and associated MCL injury, treated with operative or nonoperative management, by comparing each group with uninjured matched controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Male professional soccer and rugby players who underwent ACLR with an MCL injury, which was treated either operatively or nonoperatively, between 2015 and 2022 were each compared with 5 uninjured control players matched by age, sport, playing position, league, match appearances, and minutes played in the 12 months before injury. Kaplan-Meier survival analysis and Cox proportional hazards regression models were created. RESULTS: Overall, 90.4% (soccer, 92.6%; rugby, 87.5%) of players with ACLR+MCL injuries returned to play at 11.6 ± 4.1 months, which was similar to the 91.5% rate (soccer, 92.8%; rugby, 89.5%) of uninjured control players still competing at 11 months after the operation date of their matched player with injury. At 2 years postsurgery 81.9% of all injured athletes were still competing compared to 81.3% in the control group. This decreased to 61.7% and 62.8%, respectively, at 5 years postsurgery. There was no difference between the still playing rates of the ACLR+MCL operative group 2 and 5 years postsurgery compared to their uninjured controls (2 years: 75.0% vs 75.9%; 5 years: 37.5% vs 41.5%) or between the ACLR+MCL nonoperative group and their uninjured controls (2 years: 86.2% vs 84.6%; 5 years: 70.5% vs 70.8%). Age, sport, and competition level all had a significant effect on retirement risk, but being injured did not. After controlling for age, sport, and level played, the median career length was 7.07 years in the uninjured group compared to 6.68 years in the ACLR+MCL injury group. CONCLUSION: After ACLR with either operative or nonoperative management of an associated MCL injury, professional soccer and rugby players have high rates of RTP and maintain career longevity equal to that of a player without injury if the severity of the MCL injury is recognized and treated appropriately.