Anterior cruciate ligament injury is rarely the last dance for professional basketball players: High return to play with longer recovery times. A systematic review and meta-analysis

IF 3.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-12-01 Epub Date: 2025-10-21 DOI:10.1016/j.jisako.2025.101023

Riccardo D'Ambrosi MD , Derya Akbaba MD , Alessandro Carrozzo MD , Lorenzo Tagliabue MD , Luca M. Sconfienza MD , Elmar Herbst MD PhD , Elisabeth Abermann MD , Christian Fink MD

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Abstract

Importance

Anterior cruciate ligament (ACL) injuries are considered one of the most serious setbacks for professional basketball players. While return to play (RTP) is commonly achieved in other sports, the impact of ACL reconstruction (ACLR) on RTP rate, timing, and re-rupture in elite basketball remains unclear.

Aim

To evaluate the rate, timing, and level of RTP, as well as re-rupture rates, in professional basketball players following ACL reconstruction, and to assess whether these outcomes have changed over time. We hypothesized that while overall RTP rates would remain high, time to RTP may have increased over the past decade, reflecting evolving rehabilitation protocols and return to sport criteria.

Evidence review

A comprehensive search of PubMed, Embase, and Cochrane Library was performed (last updated July 2025) following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies were included if they reported RTP outcomes in skeletally mature professional basketball players after primary ACLR. Four distinct outcome measures were extracted and documented: RTP, time to RTP, level of RTP, and ACL re-rupture. Meta-regression was performed based on the publication period (before 2016, 2016-2020, after 2020).

Findings

Eight studies were included. The pooled RTP rate was 86.8% (95% confidence interval [CI], 79.5-92.8%), with 97.2% (95% CI, 86.9-100.0%) of players returning to their pre-injury level. The mean time to RTP was 367 days (95% CI, 357-376), increasing significantly in recent years (p = 0.012). The overall ACL re-rupture rate was 1.8% (95% CI, 0.2-4.6%). No significant differences were observed in RTP or re-rupture rates across time periods, but a progressive increase in time to RTP was noted.

Conclusion

Professional basketball players achieve high rates of RTP after ACLR, with most returning to their pre-injury level. Re-rupture rates are low; however, time to RTP has increased in recent years, likely reflecting more conservative, criteria-based rehabilitation strategies. ACL injury is no longer a career-ending event in elite basketball but a longer and more complex recovery may be required.

Level of Evidence

Level IV.

Registration

PROSPERO Registry (CRD420251113289).

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前交叉韧带损伤很少是职业篮球运动员的最后一舞：高恢复时间较长。系统回顾和荟萃分析。

重要性：前交叉韧带（ACL）损伤被认为是职业篮球运动员最严重的挫折之一。虽然在其他运动中通常可以实现恢复比赛（RTP），但在精英篮球运动中，ACL重建（ACLR）对RTP率、时间和再破裂的影响尚不清楚。目的：评估职业篮球运动员ACL重建后的恢复率、时间和水平，以及再破裂率，并评估这些结果是否随着时间的推移而改变。我们假设，虽然总体RTP率仍然很高，但RTP的时间可能在过去十年中有所增加，这反映了不断发展的康复方案和重返运动标准。证据回顾：根据PRISMA指南，对PubMed、Embase和Cochrane图书馆进行了全面检索（最后一次更新于2025年7月）。如果研究报告了骨骼成熟的职业篮球运动员在原发性ACLR后的RTP结果，则将其纳入研究。提取并记录了四个不同的结果测量指标：RTP；到RTP的时间：RTP的水平：ACL再破裂。基于出版期（2016年前、2016-2020年、2020年后）进行meta回归。结果：纳入8项研究。总的RTP率为86.8%(95%可信区间[CI]， 79.5-92.8%), 97.2% （95% CI, 86.9-100.0%）的运动员恢复到伤前水平。平均RTP时间为367天（95% CI, 357-376），近年来显著增加（p=0.012）。总体ACL再破裂率为1.8% （95% CI, 0.2-4.6%）。RTP或再破裂率在不同时间段内没有显著差异，但到RTP的时间逐渐增加。结论：职业篮球运动员ACLR后的RTP率较高，大部分恢复到伤前水平。再破裂率低；然而，近年来进行RTP的时间有所增加，这可能反映了更保守的、基于标准的康复策略。前交叉韧带损伤不再是精英篮球生涯的终结事件，但可能需要更长的时间和更复杂的恢复。证据级别：四级注册：普洛斯彼罗注册（CRD420251113289）。

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