Physiotherapy Outcomes and Return to Sport Criteria Post-ACL Reconstruction: A Systematic Review of Contemporary Measurement Tools
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Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in physically active individuals and athletes, often requiring comprehensive physiotherapy rehabilitation following ACL reconstruction (ACLR) to optimize functional recovery and facilitate a safe return to sport (RTS). Although numerous contemporary assessment tools have been developed to evaluate rehabilitation outcomes, evidence integrating physiotherapy outcomes, assessment instruments, and RTS criteria remains limited. This study aimed to synthesize current evidence on physiotherapy outcomes following ACLR, compare contemporary assessment tools, and examine their contributions to evidence-based RTS decision-making. A systematic literature review (SLR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified through scientific databases using predefined eligibility criteria, including English-language studies published between 2021 and 2026. Thirty eligible studies were included in the final review and analyzed through narrative synthesis. The findings indicated that physiotherapy rehabilitation was associated with improvements in knee function, muscle strength, functional performance, patient-reported outcomes, and psychological readiness for RTS. A comprehensive evaluation of RTS readiness required the integration of objective functional assessments, including hop tests, the Limb Symmetry Index (LSI), and isokinetic strength testing, with patient-reported outcome measures (PROMs), such as the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Knee Injury and Osteoarthritis Outcome Score (KOOS), alongside psychological readiness assessment using the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale. These findings suggested that a multidimensional, criterion-based assessment framework provided a more comprehensive evaluation of RTS readiness than reliance on postoperative time alone, thereby supporting individualized rehabilitation planning and evidence-based physiotherapy practice following ACLR.
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