It used to be that you might see someone walking with some difficulty and they might say 'old football injury'. 

That happens less and less, as long as they didn't have a long career as an offensive lineman. The anterior cruciate ligament is one of four that connect the thigh bone to the shin bone. Over-stretching or tearing of this ACL, partially or completely, used to be quite common - and career-ending.

Today, that is not the case, even at the high school and college levels. A new paper at the American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day finds that even elite college football players frequently return to the field after an ACL reconstruction. The study adds to earlier research by exploring specific factors that affected return to play, including player standing on rosters and year in school.

"Our data shows that about 82% of Division 1 NCAA football players return after ACL surgery, with that percentage reaching up to 94% when we focus on players who were starters before being injured," commented lead author Dr. Jimmy Hoshang Daruwalla from the Emory University Department of Orthopaedics in Atlanta. "Athletes who rarely saw playing time returned about 73% of the time, while those who saw at least some playing time returned at a rate of about 88%."

The study used data from 13 institutions in major Division 1 FBS conferences, including the Southeastern Conference (SEC), Atlantic Coast Conference (ACC) and Pacific 12 (Pac-12). A total of 184 athletes participated, with 151 of the general group returning to play. Sophomores and juniors returned approximately 90% of the time, with scholarship players returning approximately 87.6% of the time.

"Our research shows that returning from a major knee injury and surgery is definitely possible. Furthermore, we've found that the more motivated and skilled players are more likely to achieve this goal," noted Daruwalla. "Sports medicine specialists will be able to use this data to help counsel players and tailor treatments for these collegiate athletes."