Anterior Cruciate Ligament Injuries in Tennis: Injury Mechanism and Return to Sport Rates Following Injury

The prevalence and injury mechanism of ACL injuries in tennis are not well documented. This study aimed to report the mechanism of ACL injury in tennis, particularly whether it is linked to specific court positions or movements, and to evaluate how many tennis players return to tennis and to which level. Patients in Denmark diagnosed with ACL rupture from 2000 to 2018, registered in the Danish National Patient Register (DNPR) were asked about injury mechanism. Participants completed an online questionnaire describing court locations and movement preceding the injury. Additionally, patients registered in DNPR with a diagnosis of ACL rupture and tennis as their primary sport were asked about return to sport (RTS) and return to performance (RTP) after their injury. Seventy-four participants reported sustaining an ACL injury while playing tennis. Lunging, running forward to the net, and movements related to smashing were the most frequent activities leading to injury. A total of 231 patients with an ACL injury identified tennis as their primary sport. Among them, 126 (72%) achieved RTS and 43 (25%) reached RTP. Tegner score significantly decreased among recreational (median from 6 to 4, p = 0.014) and tournament players (median from 7 to 6, p < 0.001). Treatment type (operative vs. non-operative) did not significantly influence RTS or RTP. Overall, lunging, forward run to the net, or injury in relation to a smash were the most common movements preceding ACL injury in tennis. A majority (72%) of injured players returned to tennis, while a smaller proportion (25%) achieved RTP.