Evidence map›Paper›PMID 41385008›Full record

SynthesisSports medicine - open2025

Slower but Not Safer: A Systematic Review and Meta-Analysis of Return to Play and Graft Re-Rupture After ACL Reconstruction in Professional Soccer Players.

Riccardo D'Ambrosi, Alessandro Carrozzo, Edoardo Monaco, Amit Meena, Luca Maria Sconfienza, Elmar Herbst, Elisabeth Abermann, Christian Fink

Abstract readSystematic Review
In one paragraph

Synthesis in Sports medicine - open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Riccardo D'AmbrosiIRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy. riccardo.dambrosi@hotmail.it.ORCID http://orcid.org/0000-0002-1216-792X
Alessandro CarrozzoDipartimento di Sanità Pubblica e Malattie Infettive, La Sapienza University, Rome, Italy.
Edoardo MonacoSant'Andrea University Hospital, La Sapienza University of Rome, Rome, Italy.
Amit MeenaDepartment of Orthopaedics, Shalby Hospital, Jaipur, India.
Luca Maria SconfienzaIRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
Elmar HerbstDepartment of Trauma, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany.
Elisabeth AbermannGelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria.
Christian FinkGelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnterior cruciate ligament (ACL) rupture is one of the most severe injuries in professional soccer players, often leading to long absences from competition and career-threatening consequences. Understanding how return to play (RTP) outcomes have evolved over time is essential for optimizing recovery and minimizing re-injury risk. The aim of this systematic review and meta-analysis was to compare RTP rate, level of RTP, time to RTP, and ACL graft re-rupture rate in professional soccer players across three distinct time periods after ACL reconstruction (ACLR).

methodsFollowing PRISMA guidelines, MEDLINE (PubMed), Embase (Elsevier), and the Cochrane Library were systematically searched on March 8, 2025, and updated on March 22, 2025. Studies reporting RTP outcomes after ACLR in professional soccer players were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Four primary outcomes-RTP rate, level of RTP, time to RTP, and ACL graft re-rupture rate-were extracted and meta-analyzed across three publication periods (2011-2016, 2017-2021, 2022-2025).

resultsTwenty studies met the inclusion criteria, comprising 1,988 professional soccer players (5 published before 2017, 5 between 2017 and 2021, and 10 after 2021). The mean player age at surgery did not differ across time periods (p > 0.05). Overall, 92.3% of players returned to play, 80.1% regained their pre-injury performance level. The mean time to RTP was 263.2 days, with a significantly slower return observed in 2022-2025 (295.1 days) compared with 2011-2016 (203.5 days; p = 0.006), and the pooled graft re-rupture rate was 8.2%. No significant differences were found among periods for overall RTP, level of RTP, or re-rupture rate (p > 0.05).

conclusionMore than 92% of professional soccer players successfully RTP after ACLR, and approximately 80% recover their pre-injury level. However, in recent years, RTP has become significantly slower-by over 40%-without a corresponding reduction in graft re-rupture rates. These findings suggest a shift toward more conservative, criteria-based RTP decision-making in professional soccer, reflecting greater emphasis on graft protection and long-term knee health. Level of Evidence Systematic review and meta-analysis of level IV. Trial Registration PROSPERO - CRD420251012143.

Indexed as

ACLRe-ruptureReturn to sportSoccerTime to return

Identifiers

PMID41385008
PMCPMC12701112

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.