Long-term changes in playing time, competitive level, and market value after ACL reconstruction in elite Spanish professional football players

PURPOSE: The purpose of this study was to evaluate the epidemiology and longitudinal postinjury changes in playing time, competitive level, and market value in professional male football players from Spain's First Division following anterior cruciate ligament reconstruction. METHODS: This retrospective cohort study included 132 anterior cruciate ligament injuries in 115 professional football players identified between the 2010-2011 and 2023-2024 seasons using public databases (Transfermarkt and BeSoccer), with cross-validation against official medical reports or news sources. Return to play, league level, minutes played, and market value were tracked up to 5 years postinjury. Statistical analyses included chi-squared tests, repeated-measures analysis of variance (ANOVA), mixed-effects models with Dunnett-adjusted comparisons, Wilcoxon signed-rank testing, and exploratory multivariate regression analyses. RESULTS: The mean age at injury was 26.7 years. The return to play rate was 97.7%, with a mean return to play time of approximately 9.1 months. The first competitive appearance occurred at a median of 13.5 days after the first matchday squad inclusion. However, 35.2% of players dropped at least one competitive league level by the first postinjury season, increasing to 61.3% by the fifth season. Minutes played decreased by 46% in the first postinjury season (p < 0.001), with only partial recovery thereafter. Minutes per match played remained approximately 21 min below preinjury values during both the first and second postoperative seasons (both p < 0.001). Market value declined significantly across follow-up, reaching up to a 47.7% reduction by year 5, particularly among players aged 30 years or older. CONCLUSIONS: Longitudinal reductions in playing time, competitive level, and market value were observed following ACL injury in professional football players, despite high return to play (RTP) rates. Reduced minutes per match played further indicated persistent limitations in competitive utilization during the first two postoperative seasons.