Anterior Cruciate Ligament Injury Is Rarely the Last Dance for Professional Basketball Players: High Return to Play with Longer Recovery Times. A Systematic Review and Meta-analysis

Importance: Anterior cruciate ligament (ACL) injuries are considered one of the most serious setbacks for professional basketball players. While return to play (RTP) is commonly achieved in other sports, the impact of ACL reconstruction (ACLR) on RTP rate, timing, and re-rupture in elite basketball remains unclear. Aim: To evaluate the rate, timing, and level of return to play, as well as re-rupture rates, in professional basketball players following ACL reconstruction, and to assess whether these outcomes have changed over time. We hypothesized that while overall RTP rates would remain high, time to RTP may have increased over the past decade, reflecting evolving rehabilitation protocols and return-to-sport criteria. Evidence review: A comprehensive search of PubMed, Embase, and Cochrane Library was performed (last updated July 2025) following PRISMA guidelines. Studies were included if they reported RTP outcomes in skeletally mature professional basketball players after primary ACLR. Four distinct outcome measures were extracted and documented: RTP; time to RTP: level of RTP: ACL re-rupture. Meta-regression was performed based on publication period (pre-2016, 2016-2020, post-2020). Findings: Eight studies were included. The pooled RTP rate was 86.8% (95% Confidence Interval [CI], 79.5-92.8%), with 97.2% (95% CI, 86.9-100.0%) of players returning to their pre-injury level. The mean time to RTP was 367 days (95% CI, 357-376), increasing significantly in recent years (p=0.012). The overall ACL re-rupture rate was 1.8% (95% CI, 0.2-4.6%). No significant differences were observed in RTP or re-rupture rates across time periods, but a progressive increase in time to RTP was noted. Conclusion: Professional basketball players achieve high rates of RTP after ACLR, with most returning to their pre-injury level. Re-rupture rates are low; however, time to RTP has increased in recent years, likely reflecting more conservative, criteria-based rehabilitation strategies. ACL injury is no longer a career-ending event in elite basketball, but a longer and more complex recovery may be required. Level of evidence: Level IV REGISTRATION: PROSPERO Registry (CRD420251113289).