ACL Injury in Athletes: Return to Competition

Abstract

This systematic review critically evaluates the diverse criteria employed for determining an athlete's readiness to return to sport following an anterior cruciate ligament injury, aiming to synthesize current evidence-based guidelines and identify key decision-making parameters. It addresses the variability in return-to-sport testing protocols and explores the efficacy of incorporating objective functional assessments, patient-reported outcomes, and psychological readiness measures to mitigate re-injury risk. Anterior cruciate ligament injuries represent a significant career-altering event for athletes, with only about 55% returning to pre-injury competitive levels despite advances in surgery and rehabilitation. Re-injury rates remain high, particularly 17-19% in adolescents, compounded by gaps between expectations and outcomes, and a lack of standardized criteria leading to inconsistent clinical practices. This comprehensive analysis provides clearer guidance on safe RTS timing, bridging clinical outcomes and athletic performance. It investigates rehabilitation strategies and psychosocial factors influencing RTS rates—critical for elite athletes—and highlights challenges from absent universal testing procedures post-ACL reconstruction. Ultimately, the review proposes strategies to reduce re-injury risk and enhance long-term athletic careers.