Advanced Analytics Show Domain‐Specific Performance Changes After Anterior Cruciate Ligament Reconstruction in National Football League Players

Purpose To evaluate return to play, performance, and assess performance changes after anterior cruciate ligament reconstruction using advanced statistics in National Football League players. Methods National Football League players who underwent anterior cruciate ligament reconstruction (ACLR) between 2017 and 2024 were identified using publicly available databases and injury reports. Demographic and outcome data for 1 year preinjury to 2 years postinjury were obtained. Return to play was defined as being listed as active for a regular season game after injury. Return to performance was defined as returning to greater than 90% of preinjury performance. Our primary performance outcome was Sports Information Solutions points above replacement (PAR). Binary logistic regression was used to determine factors associated with return to play and return to performance. Preinjury and postinjury performance data at the first and second postinjury year were compared with paired t ‐tests. Results We included 237 players in return‐to‐play and 173 players in return‐to‐performance analyses. Of players, 75.5% returned to play; players with more preinjury games played, more index games played, starters, and players with greater preinjury PAR were more likely to return to play ( P = .03, P < .001, P < .001, P < .001, respectively). Fifty‐one percent of players who returned to play returned to performance; younger age and players with lower preinjury PAR were significantly more likely to return to performance ( P = .004, P < .001). Total PAR was significantly decreased at the postinjury year 1 and year 2 seasons ( P = .002, P = .004), driven at both time points by significantly decreased rushing ( P = .02, P = .001) and pass coverage ( P = .003, P = .03) PAR. Conclusions After anterior cruciate ligament reconstruction, National Football League players with more preinjury games played and higher preinjury performance are more likely to return to play; younger players with lower preinjury performance are more likely to return to performance; and there is a significant decrease in overall performance 1 and 2 years after injury, driven by decreased rushing and pass coverage performance. Level of Evidence Level IV, retrospective case series.