Nonsurgical Anterior Cruciate Ligament Rehabilitation: A Scoping Review of Exercise Descriptors and Return-to-Sport Outcomes

Abstract

Context:

Anterior cruciate ligament (ACL) injuries are common in athletes, especially in pivoting sports. While surgical reconstruction is standard, nonsurgical management remains a viable option for selected patients. However, limited guidance exists on effective rehabilitation protocols for this population. The purpose of this review was to identify and summarize the rehabilitation strategies used in nonsurgical management for patients with ACL deficiency (ACL-D), with particular attention to exercise-based components.

Evidence Acquisition:

Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, studies were included based on the PCC framework, focusing on athletes aged >14 years with ACL injuries undergoing nonsurgical management. Four databases (MEDLINE, EMBASE, CINAHL, PEDro) were searched up to June 2024, with additional manual screening. Two reviewers independently screened and extracted data. A narrative synthesis was conducted, and exercises were categorized using established frameworks. Inter-rater reliability was assessed using Cohen’s kappa.

Study Design:

Scoping review.

Level of Evidence:

Level 4.

Results:

A total of 14 studies involving 570 athletes (aged 14-57 years) were included. Of these, 53% completed rehabilitation without surgery, and 30% returned to sport. Protocols varied significantly, with a mean duration of 12 ± 8 weeks. Interventions focused on strength (48%), neuromuscular control (10%), and sport-specific exercises (25%). Patient-reported outcome measures were used in 71% of studies. Associated injuries were reported in 33% of studies and negatively influenced return to sport (RTS) outcomes.

Conclusion:

Notable inconsistencies in nonsurgical management of ACL-D protocols and exercise descriptors limit comparability and the development of standardized guidelines. Short rehabilitation duration may partly explain the low RTS rate (30% of the original cohort) and the high reinjury rate (28%). Structured, progressive programs focusing on strength, neuromuscular training, and psychological readiness may be important to improve outcomes.