CLINICAL AND FUNCTIONAL CRITERIA FOR RETURN TO SPORT AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Abstract

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed procedures in sports orthopedics, especially among young and physically active individuals. Despite advances in surgical techniques and rehabilitation protocols, determining the safe timing for return to sport remains a significant clinical challenge, as decisions based exclusively on postoperative time have been associated with a higher risk of reinjury and unsatisfactory functional outcomes. This study aimed to analyze, through a systematic literature review, the main clinical, functional, and psychological criteria used to guide return to sport after ACL reconstruction. A search was conducted in the PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases, including studies published between 2015 and 2025. Clinical trials, observational studies, and systematic reviews evaluating outcomes related to return to sport in patients undergoing ACL reconstruction were selected. Data were qualitatively analyzed considering parameters such as muscle strength, functional tests, limb symmetry, psychological readiness, return-to-sport timing, and risk of reinjury. A total of 25 studies were included in the final analysis. Objective functional criteria, particularly those based on limb symmetry indexes equal to or greater than 90%, were associated with better clinical outcomes. Psychological factors, such as confidence in the operated knee and absence of fear of reinjury, also demonstrated significant influence on return-to-sport rates. On the other hand, early return to sport, particularly before nine months, was associated with a higher risk of new injury. It is concluded that return to sport after ACL reconstruction should be guided by a multifactorial approach integrating clinical, functional, and psychological criteria. The adoption of this strategy may contribute to greater safety in return to sport, reduction in reinjury risk, and optimization of functional outcomes.