Return to Sport Following ACL Repair: A Systematic Review

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 a 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 RTS 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, and SPORTDiscus databases was performed on October 11, 2024. Two independent reviewers screened 2,098 articles. The inclusion criteria included studies from 2000 to the present, a minimum of 12-month follow-up, level of evidence (LOE) I to IV, 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 RTS ranged from 5.9 to 11.9 months. ACL repair with bone marrow stimulation achieved RTS rates ranging from 78% to 92%. Primary repair techniques demonstrated RTS rates from 67% to 100%, while primary repair with internal brace techniques demonstrated RTS rates ranging from 36% to 100%. RTS rates following the Bridge-Enhanced ACL Repair (BEAR) technique were only reported in one study, and reported an RTS rate at 88%. The majority of patients undergoing ACL repair RTS, with a majority also returning to preinjury levels between 4 and 11.9 months postsurgery. ACL repair techniques are a viable treatment option in the correct patient population.LOE is IV; systematic review of level IV studies.