Return to Sport Following ACL Repair: A Systematic Review.

Abstract

Anterior cruciate ligament (ACL) injuries are among the most common sports-related knee injuries, affecting athletes across varying levels of competition. ACL repair procedures have become a popular treatment option to repair these lesions. There is a need for comprehensive analysis of recent studies among a growing body of literature to better understand return to sport (RTS), return to previous level (RPL), and timing of return to sport following these procedures. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search of PubMed, Embase, Scopus, SportsDISCUS databases was performed on October 11, 2024. Two independent reviewers screened 2098 articles. The inclusion criteria were: studies from 2000 to present, minimum of 12 month follow up, level of evidence 1-4, English language, and reported outcomes after ACL repair procedures with RTS data. Data were stratified by ACL repair technique for subgroup analysis. RTS, RPL, and RTS timing were reported as ranges to reflect study variability. The 16 studies included 614 athletes with RTS rates ranging from 36% to 100%. Seven studies report RPL encompassing 342 athletes with RPL rates ranging from 60% to 81%. The average time for athletes to return to sport ranged from 5.9 months to 11.9 months. ACL repair with bone marrow stimulation achieved RTS rates ranging from 78-92%. Primary repair techniques demonstrated RTS rates from 67-100%, while primary repair with internal brace techniques demonstrated RTS rates ranging from 36-100%. RTS rates following the BEAR technique were only reported in one study and reported a return to sport rate at 88%. The majority of patients undergoing ACL repair return to sport with a majority also returning to pre-injury levels between 4-11.9 months post-surgery. ACL repair techniques are a viable treatment option in the correct patient population.