Evidence-Based Interventions and Functional Outcomes for Return to Sport After ACL Reconstruction: A Systematic Review and Meta-analysis.

Abstract

Rehabilitation is pivotal in supporting return-to-sport (RTS) outcomes following anterior cruciate ligament reconstruction (ACLR); however, inconsistencies in intervention protocols, assessment metrics, and psychological support challenge clinical decision-making. This systematic review and meta-analysis evaluated the clinical effectiveness of multidisciplinary rehabilitation strategies-including strength training, neuromuscular re-education, psychological readiness, blood flow restriction (BFR) therapy, and wearable sensor technologies-on functional recovery and RTS outcomes post-ACLR. Based on bibliometric trends showing substantial growth in ACLR research, a comprehensive literature search of Scopus, PubMed, Web of Science, and IEEE Xplore databases from 2018 to 2024 was conducted. A total of 73 studies were included. Pooled standardized mean differences (SMDs) were computed using random-effects meta-analyses. Methodological quality and evidence strength were assessed via AMSTAR-2 and GRADE tools. Strength and neuromuscular training significantly enhanced quadriceps recovery and limb symmetry (SMD = 0.64; <i>p</i> < 0.01), while BFR therapy showed large effects on hypertrophy and early function (SMD = 1.28; <i>p</i> < 0.0001). Psychological readiness (e.g., ACL-RSI, IKDC) strongly predicted RTS (SMD = 0.82; <i>p</i> < 0.0001). Wearable sensors and machine learning models improved gait tracking and RTS prediction (SMD = 0.46; <i>p</i> < 0.0001), though protocol variability persisted. Multimodal rehabilitation integrating physical, psychological, and technological domains optimizes RTS outcomes post-ACLR. Standardizing intervention criteria and validating sensor-based and AI-supported tools are essential next steps for evidence-based clinical translation.<b>PROSPERO Registration: CRD</b>42024561002.