🦵 ACL Injury? Surgery or Rehab Alone? New Study Finds No Difference in Return to Sport!
Ref: No Difference in Return-to-Sport Rate or Activity Level in People with Anterior Cruciate Ligament (ACL) Injury Managed with ACL Reconstruction or Rehabilitation Alone.”(Authors: Stephanie R. Filbay et al., Sports Medicine, published July 2, 2025)e
A newly published systematic review and meta-analysis by Filbay and colleagues examined 15 studies (18 articles) including 1,637 participants with ACL injuries. The review compared outcomes between those treated with ACL reconstruction (ACLR) and those managed with structured, supervised rehabilitation alone. Contrary to common belief, the study found no significant difference in return-to-sport (RTS) rates or activity levels between the two groups.
Across the included studies, 48% (172 out of 358) of individuals in the ACLR group returned to sport, compared to 45% (134 out of 300) in the rehabilitation-alone group. While ACLR was associated with a slightly higher Tegner Activity Scale score (mean difference of 0.7), this was below the threshold for clinical significance. Importantly, most of the studies were found to have confounding biases favoring surgery—for example, by advising rehab participants not to return to sport—yet the results still showed no clear advantage to surgical intervention. The overall certainty of the evidence was graded as low to very low.
📊 2-Year Follow-Up Data:
One included trial reported that 43% of individuals who underwent early ACLR had returned to sport at the 2-year follow-up, compared to 31% of those who initially received rehabilitation with the option of delayed ACLR. These findings are in line with results from the well-known KANON trial, where 39% of the rehabilitation/delayed ACLR group and 44% of the early ACLR group had returned to sport at 2 years. This suggests that while the timeline to return may differ slightly, the overall likelihood of returning to sport over time remains similar across treatment approaches.
This review challenges the prevailing assumption that ACL reconstruction is necessary for returning to sport in particularly pivoting or cutting activities. Instead, it highlights that rehabilitation alone may be an equally viable path for many individuals, supporting a more nuanced and patient-centered approach to treatment decision-making.
🔗 Read the full article: https://doi.org/10.1007/s40279-025-02268-5
