High return to play but low return to preinjury level after anterior cruciate ligament reconstruction in soccer players: A systematic review with meta-analysis.

Abstract

This systematic review with meta-analysis aimed to quantify return to play (RTP) outcomes in soccer players after anterior cruciate ligament reconstruction (ACLR), including the rate of RTP, time to RTP, rate of return to preinjury level of sport, and secondary ACL injury. Additionally, the meta-analysis sought to explore the impact of sex and competitive level on RTP outcomes. Five databases were searched to identify studies including soccer players who underwent ACLR and that evaluated RTP outcomes. Outcomes included the rate of RTP, time to RTP, rate of return to preinjury level of sport and secondary ACL injury. Data were transformed using Freeman-Tukey double arcsine and analyzed with a random-effects model to calculate pooled rates and 95% confidence intervals (CIs). Subgroup analyses were conducted based on sex and competitive level. Thirty-nine studies with 7452 players were included. The pooled RTP rate was 83% (95% CI, 77%-89%), while 60% (95% CI, 49%-71%) returned to preinjury level. Mean time to RTP was 9.1 months (95% CI, 8.2-10.1). The secondary ACL injury rate was 15% (95% CI, 12%-19%), with 9% ipsilateral and 10% contralateral. Subgroup analyses showed significantly higher RTP rates in males (86%) and elite athletes (93%) than in females (72%) and non-elite athletes (64%), while secondary ACL injuries were more frequent in females (20%) and non-elite athletes (22%) than in males (13%) and elite athletes (12%). Most soccer players returned to any level of play within 9.1 months after ACLR. However, only three in five players returned to their preinjury levels. Furthermore, the secondary ACL injury rate was high, with 15% of soccer players sustaining either ipsilateral or contralateral ACL re-injuries. These findings highlight the need for tailored rehabilitation programs and strict RTP criteria to facilitate return to preinjury level and prevent secondary ACL injury. Level III.