Anterior Cruciate Ligament Injuries in Athletes: Risk Factors, Mechanisms, Treatment, and Return-to-Sport Outcomes – A Narrative Review
DOI:
https://doi.org/10.12775/JEHS.2026.94.72914Keywords
athletes, anterior cruciate ligament, ACL injury, return to sport, rehabilitation, risk factorsAbstract
Background: Anterior cruciate ligament (ACL) injury is a common and serious injury in athletes, particularly in sports involving pivoting, jumping, and rapid direction changes. ACL rupture may result in knee instability, reduced performance, prolonged absence from sport, and increased risk of osteoarthritis.
Aim: The aim of this study was to summarize current evidence regarding risk factors, treatment, rehabilitation, and return-to-sport outcomes after ACL injury in athletes.
Materials and methods: This narrative review analyzed current literature on ACL injuries in athletes. Studies concerning epidemiology, injury mechanisms, treatment strategies, rehabilitation, and return to sport were identified using PubMed, Scopus, and Google Scholar. English-language publications from 2000–2024 were included.
Results: ACL injury is multifactorial and strongly associated with neuromuscular and biomechanical deficits. Prevention programs focused on neuromuscular training may reduce injury risk. ACL reconstruction combined with structured rehabilitation remains the preferred treatment for many athletes. Criteria-based return-to-sport assessment is increasingly recommended to reduce re-injury risk.
Conclusions: Effective ACL injury management requires prevention, individualized rehabilitation, and evidence-based return-to-sport decisions. Despite advances in treatment, the risk of secondary injury remains significant.
References
1. Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34(9):1512-1532. doi:10.1177/0363546506286866
2. Beynnon BD, Vacek PM, Newell MK, et al. The effects of level of competition, sport, and sex on the incidence of first-time noncontact ACL injury. Am J Sports Med. 2014;42(8):1806-1812. doi:10.1177/0363546514540862
3. Waldén M, Hägglund M, Magnusson H, Ekstrand J. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc. 2011;19(1):11-19. doi:10.1007/s00167-010-1170-9
4. Sanders TL, Maradit Kremers H, Bryan AJ, et al. Incidence of anterior cruciate ligament tears and reconstruction. Am J Sports Med. 2016;44(6):1502-1507. doi:10.1177/0363546516629944
5. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis. Br J Sports Med. 2011;45(7):596-606. doi:10.1136/bjsm.2010.076364
6. Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009;37(7):1434-1443. doi:10.1177/0363546509338827
7. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756-1769. doi:10.1177/0363546507307396
8. Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: part 1, mechanisms and risk factors. Am J Sports Med. 2006;34(2):299-311. doi:10.1177/0363546505284183
9. Shultz SJ, Schmitz RJ, Nguyen AD. ACL Research Retreat V: an update on ACL injury risk and prevention. J Athl Train. 2010;45(5):499-508. doi:10.4085/1062-6050-45.5.499
10. Griffin LY, Agel J, Albohm MJ, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8(3):141-150. doi:10.5435/00124635-200005000-00001
11. Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis. Am J Sports Med. 2007;35(3):359-367. doi:10.1177/0363546506293899
12. Hewett TE, Myer GD, Ford KR. Biomechanical measures of neuromuscular control and valgus loading predict ACL injury risk in female athletes. Am J Sports Med. 2005;33(4):492-501. doi:10.1177/0363546504269591
13. Frobell RB, Roos HP, Roos EM, et al. Treatment for acute anterior cruciate ligament tear: randomized controlled trial. N Engl J Med. 2010;363:331-342. doi:10.1056/NEJMoa0907797
14. Kaplan Y, Witvrouw E. When is it safe to return to sport after ACL reconstruction? Reviewing the criteria. Sports Health. 2019;11(4):301-305. doi:10.1177/1941738119846502
15. Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543-1552. doi:10.1136/bjsports-2013-093398
16. Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of secondary ACL injury in athletes: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861-1876. doi:10.1177/0363546515621554
17. Hashemi J, Chandrashekar N, Gill B, et al. The geometry of the tibial plateau and ACL injury risk. J Bone Joint Surg Am. 2008;90(10):2035-2042. doi:10.2106/JBJS.G.01141
18. Shelbourne KD, Davis TJ, Klootwyk TE. The relationship between intercondylar notch width and ACL injury. Am J Sports Med. 1998;26(3):402-408. doi:10.1177/03635465980260031101
19. Myer GD, Ford KR, Hewett TE. Neuromuscular deficits and ACL injury risk. Clin Orthop Relat Res. 2006;455:138-147. doi:10.1097/01.blo.0000224053.90352.7f
20. Hewett TE, Torg JS, Boden BP. Video analysis of ACL injuries: clinical implications. Am J Sports Med. 2009;37(1):73-79. doi:10.1177/0363546508325669
21. Wojtys EM, Huston LJ, Lindenfeld TN, et al. Association between menstrual cycle and ACL injuries. Am J Sports Med. 1998;26(5):614-619. doi:10.1177/03635465980260050301
22. Posthumus M, September AV, O’Cuinneagain D, et al. Genetic risk factors for ACL ruptures. Br J Sports Med. 2009;43(5):352-357. doi:10.1136/bjsm.2008.056150
23. Orchard J, Seward H. Football injuries and playing surface. Br J Sports Med. 2002;36(2):95-99. doi:10.1136/bjsm.36.2.95
24. McLean SG, Samorezov JE. Fatigue and ACL injury risk. Clin Biomech. 2009;24(7):589-594. doi:10.1016/j.clinbiomech.2009.04.001
25. van Grinsven S, van Cingel REH, Holla CJM, van Loon CJM. Evidence-based rehabilitation following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1128-1144. doi:10.1007/s00167-009-1027-2
26. Fitzgerald GK, Axe MJ, Snyder-Mackler L. A decision-making scheme for returning patients to sport after ACL injury. J Orthop Sports Phys Ther. 2000;30(4):194-203. doi:10.2519/jospt.2000.30.4.194
27. Xie X, Liu X, Chen Z, et al. A meta-analysis of patellar tendon versus hamstring tendon autografts. Knee. 2015;22(2):100-110. doi:10.1016/j.knee.2014.11.014
28. Desai N, Björnsson H, Musahl V, et al. Anatomic single- versus double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):1009-1023. doi:10.1007/s00167-013-2787-6
29. Adams D, Logerstedt DS, Hunter-Giordano A, et al. Current concepts for ACL rehabilitation. J Orthop Sports Phys Ther. 2012;42(7):601-614. doi:10.2519/jospt.2012.3871
30. Filardo G, Di Matteo B, Kon E, et al. Platelet-rich plasma in tendon-related disorders. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):1984-1999. doi:10.1007/s00167-016-4261-4
31. Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk after ACL reconstruction. Br J Sports Med. 2016;50(13):804-808. doi:10.1136/bjsports-2016-096031
32. Kyritsis P, Bahr R, Landreau P, et al. Likelihood of ACL graft rupture and return to sport criteria. Br J Sports Med. 2016;50(15):946-951. doi:10.1136/bjsports-2015-095908
33. Logerstedt D, Grindem H, Lynch A, et al. Single-legged hop tests as predictors of function. Am J Sports Med. 2012;40(10):2348-2356. doi:10.1177/0363546512457551
34. Webster KE, Feller JA, Lambros C. Development and preliminary validation of the ACL-RSI scale. Phys Ther Sport. 2008;9(1):9-15. doi:10.1016/j.ptsp.2007.09.003
35. Paterno MV, Rauh MJ, Schmitt LC, et al. Incidence of second ACL injury after reconstruction. Am J Sports Med. 2014;42(7):1567-1573. doi:10.1177/0363546514530088
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Copyright (c) 2026 Krzysztof Bednarski, Natalia Kornacka, Melania Majewska, Natalia Piasecka, Izabela Rafalska, Jakub Smagoń, Martyna Kaim, Joanna Bober, Magdalena Bochenek, Wiktoria Siewiera

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