Return to sport after ACL reconstruction, meniscus and cartilage surgeries in professional soccer players: a systematic review and meta-analysis

Background: The purpose of this systematic review and meta-analysis is to evaluate and compare the effects of anterior cruciate ligament reconstruction (ACLR), meniscal surgeries, and cartilage surgeries on return to sport (RTS) outcomes in professional soccer players. Materials and methods: The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic database search was performed to identify potentially relevant research articles. Four different outcome measures (age at surgery, return to sport, time to return to sport, level of return to sport) were extracted and meta-analyzed from all included studies and compared from three different groups (ACLR, cartilage surgeries, meniscus surgeries). Results: The pooled meta-analysis showed no difference in age at surgery among groups (p > 0.05). The overall pooled return-to-sport rate was 90% (95% CI 93.3-95.9), with no significant differences between ACL reconstruction, meniscus surgeries, and cartilage surgeries (p > 0.05) Patients treated for ACLR reported a longer time (p < 0.05) to return to sport (258.05 days; 95% CI 230.48-288.93) compared with meniscus (41.11 days; 95% CI 30.22-55.93) and cartilage surgeries (135.0 days; 95% CI 130.54-139.61). Furthermore, the pooled meta-analysis showed that athletes who underwent meniscus surgeries had a higher (p < 0.05) percentage of return to sport (100%: 95% CI 86.0-100.0) compared with ACLR (80.0%; 95% CI 67.5-90.3) and cartilage treatment (94.5%; 64.2-100.0). Conclusions: For professional soccer players, ACL reconstruction, meniscus surgeries, and cartilage surgeries demonstrated a favorable RTP rate of around 90%. Nevertheless, the analysis of the level of RTS and the time to RTS was constrained by limited evidence, precluding a more objective conclusion. Level of evidence: Meta-analysis of studies of Level IV. Study registration: PROSPERO Registry (CRD420251074362).