title: Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes.
abstract: OBJECTIVE
  The primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS.
  
  
  METHODS
  Pooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively.
  
  
  METHODS
  MEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed.
  
  
  METHODS
  Studies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included.
  
  
  RESULTS
  The pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS.
  
  
  CONCLUSIONS
  Eighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Courtney C H
authors.initials: CCH
authors.lastname: Lai
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.|Division of Physiotherapy, Linköping University, Linköping, Sweden.|Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Ardern
authors.affiliation: OrthoSport Victoria, Melbourne, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Feller
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Webster
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D056352:Athletes; D054874:Athletic Performance; D006801:Humans; D020127:Recovery of Function; D000068958:Return to Sport; D012421:Rupture / Q000453:epidemiology*
keywords: anterior cruciate ligament; anterior cruciate ligament reconstruction; elite athletes; sport re-entry