Effectiveness of massage-based rehabilitation in professional and elite athletes following arthroscopic ACL reconstruction for enhancing return-to-sport (RTS): a systematic review

This systematic review evaluated the effectiveness of massage-based rehabilitation interventions in athletes undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR), with particular emphasis on return-to-sport (RTS) outcomes in professional and elite athletes. The review was conducted in accordance with PRISMA guidelines and included studies published between January 2020 and February 2026 from PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Eligibility criteria were refined to prioritize primary research directly examining massage-based or soft tissue/manual therapy interventions after ACLR. Methodological quality and the risk of bias were assessed using RoB 2 for randomized controlled trials, ROBINS-I for non-randomized studies, and relevant critical appraisal tools according to study design. The findings indicated that massage-based interventions, including sports massage, myofascial release, acupoint stimulation, percussion massage, and related manual therapies, were associated with reduced pain and oedema, improved muscle tone, enhanced proprioception, and faster functional recovery. The most favourable RTS outcomes were reported when these interventions were integrated within structured, individualized, exercise-based rehabilitation programmes. Successful RTS, commonly achieved within 6-12 months, was further supported by phased progression, sport-specific conditioning, objective functional testing, and the assessment of psychological readiness. Massage-based rehabilitation appears to be a valuable adjunct to comprehensive post-ACLR rehabilitation.