The Impact of Functional Outcomes Following Anterior Cruciate Ligament Reconstruction on Return to Sport in Basketball Players: A Systematic Review

Anterior cruciate ligament (ACL) injuries are common among basketball players and have a significant impact on athletic performance; consequently, the extent to which athletes can return to competitive level following reconstruction surgery has become a key focus of sports rehabilitation research. Basketball involves frequent jumping, rapid changes of direction and physical contact, placing high demands on lower limb strength and dynamic stability. The degree of functional recovery following surgery directly influences an athlete’s ability to participate in training and competition, and is closely linked to the risk of re-injury. Previous studies have shown that determining the timing of return to sport based solely on postoperative time does not accurately reflect actual functional status. Functional performance has gradually become the core basis for assessment, primarily encompassing muscle strength, jumping ability, dynamic balance, neuromuscular control and sport-specific performance, whilst also involving functional symmetry and subjective perceptions of recovery. These indicators influence one another and collectively determine athletic performance. Current evidence suggests that multidimensional functional assessments hold greater value than single-parameter measures, and sport-specific functional testing is increasingly being prioritised. However, issues such as discrepancies in assessment criteria and a lack of sport-specific tests persist in the research literature. The development of a comprehensive assessment system that integrates basic functional abilities with sport-specific skills will help enhance the safety and effectiveness of postoperative return to sport for basketball players.

Basketball players; anterior cruciate ligament reconstruction; functional performance; return to sport; quadriceps

1. Zemková, E. (2022). Strength and power-related measures in assessing core muscle performance in sport and rehabilitation. Frontiers in Physiology, 13, 861582. https://doi.org/10.3389/fphys.2022.861582 [Google Scholar] [Crossref]

2. Zemková, E. (2022). Physiological mechanisms of exercise and its effects on postural sway: Does sport make a difference? Frontiers in Physiology, 13, 792875. https://doi.org/10.3389/fphys.2022.792875 [Google Scholar] [Crossref]

3. Patti, A., Gervasi, M., Giustino, V., Figlioli, F., Canzone, A., Drid, P., Thomas, E., Messina, G., Vicari, D. S. S., Palma, A., & Bianco, A. (2024). The influence of ankle mobility and foot stability on jumping ability and landing mechanics: A cross-sectional study. Journal of Functional Morphology and Kinesiology, 9(2), 114. https://doi.org/10.3390/jfmk9020114 [Google Scholar] [Crossref]

4. Fukuoka, A. H., de Oliveira, N. M., Matias, C. N., Teixeira, F. J., Monteiro, C. P., Valamatos, M. J., Reis, J. F., & Gonçalves, E. M. (2022). Association between phase angle from bioelectrical impedance and muscular strength and power in physically active adults. Biology, 11(6), 884. https://doi.org/10.3390/biology11060884 [Google Scholar] [Crossref]

5. Huang, S., Zhang, H., Wang, X., Lee, W. C., & Lam, W. (2022). Acute effects of soleus stretching on ankle flexibility, dynamic balance and speed performances in soccer players. Biology, 11(3), 387. https://doi.org/10.3390/biology11030387 [Google Scholar] [Crossref]

6. Mear, E., Gladwell, V., & Pethick, J. (2023). Knee extensor force control as a predictor of dynamic balance in healthy adults. Gait & Posture, 99, 89–94. https://doi.org/10.1016/j.gaitpost.2022.11.018 [Google Scholar] [Crossref]

7. Kawama, R., Hojo, T., & Wakahara, T. (2023). Acute changes in passive stiffness of the individual hamstring muscles induced by resistance exercise: Effects of muscle length and exercise duration. European Journal of Applied Physiology, 123, 1453–1464. https://doi.org/10.1007/s00421-023-05163-4 [Google Scholar] [Crossref]

8. Halmenschlager, G. H., da Silva, J. L., de Salles, B. F., de Oliveira, L. F., & da Matta, T. T. (2025). Eccentric muscle damage in elbow flexors: Free weights vs isokinetic dynamometer in trained men. International Journal of Sports Science & Coaching. https://doi.org/10.1177/17479541251394258 [Google Scholar] [Crossref]

9. Yoshida, R., Kasahara, K., Murakami, Y., & Nakamura, M. (2024). Maximum isokinetic eccentric elbow flexor muscle force can be estimated using maximum isometric contraction force. Cureus, 16(10), e70878. https://doi.org/10.7759/cureus.70878 [Google Scholar] [Crossref]

10. Nikolaidis, M. G. (2026). Eccentric exercise and muscle damage: An introductory guide. Journal of Functional Morphology and Kinesiology, 11(2), 139. https://doi.org/10.3390/jfmk11020139 [Google Scholar] [Crossref]

11. Zhao, Q., Liu, P., & Zhang, X. (2023). Re-examining the mechanism of eccentric exercise-induced skeletal muscle damage from the role of titin. Biomedical Reports, 20(1), 14. [Google Scholar] [Crossref]

12. https://doi.org/10.3892/br.2023.1703 [Google Scholar] [Crossref]

13. Tomalka, A. (2023). Eccentric muscle contractions: From single muscle fibre to whole muscle mechanics. Pflügers Archiv - European Journal of Physiology, 475(4), 421–435. [Google Scholar] [Crossref]

14. https://doi.org/10.1007/s00424-023-02794-z [Google Scholar] [Crossref]

15. Morin, T., Souron, R., Boulaouche, I., Jubeau, M., Nordez, A., & Lacourpaille, L. (2023). Mild to moderate damage in knee extensor muscles accumulates after two bouts of maximal eccentric contractions. European Journal of Applied Physiology, 123(12), 2723–2732. [Google Scholar] [Crossref]

16. https://doi.org/10.1007/s00421-023-05257-6 [Google Scholar] [Crossref]

17. Rosvoglou, A., Fatouros, I. G., Poulios, A., et al. (2023). Recovery kinetics following eccentric exercise is volume-dependent. Journal of Sports Sciences, 41(13), 1326–1335. [Google Scholar] [Crossref]

18. https://doi.org/10.1080/02640414.2023.2272101 [Google Scholar] [Crossref]

19. Barreto, R. V., Lima, L. C., Borszcz, F. K., de Lucas, R. D., & Denadai, B. S. (2023). Acute physiological responses to eccentric cycling: A systematic review and meta-analysis. Journal of Sports Medicine and Physical Fitness, 63(10), 1051–1068. [Google Scholar] [Crossref]

20. https://doi.org/10.23736/S0022-4707.23.14971-1 [Google Scholar] [Crossref]

21. Nuzzo, J. L., Pinto, M. D., & Nosaka, K. (2023). Overview of muscle fatigue differences between maximal eccentric and concentric resistance exercise. Scandinavian Journal of Medicine & Science in Sports, 33(10), 1901–1915. [Google Scholar] [Crossref]

22. https://doi.org/10.1111/sms.14419 [Google Scholar] [Crossref]

23. Ueda, H., Saegusa, R., Tsuchiya, Y., & Ochi, E. (2023). Pedal cadence does not affect muscle damage during eccentric cycling with equivalent workload. Frontiers in Physiology, 14, 1140359. [Google Scholar] [Crossref]

24. https://doi.org/10.3389/fphys.2023.1140359 [Google Scholar] [Crossref]

25. Straub RK, Della Villa F, Mandelbaum B, Powers CM. Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes. Sports Health. 2022 Sep-Oct;14(5):758-763. doi: 10.1177/19417381211043854. [Google Scholar] [Crossref]

26. Arhos EK, Capin JJ, Buchanan TS, Snyder-Mackler L. Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training. Am J Sports Med. 2021 Feb;49(2):417-425. doi: 10.1177/0363546520980079. [Google Scholar] [Crossref]

27. Straub RK, Della Villa F, Mandelbaum B, Powers CM. Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes. Sports Health. 2022 Sep-Oct;14(5):758-763. doi: 10.1177/19417381211043854. [Google Scholar] [Crossref]

28. Markström JL, Naili JE, Häger CK. A Minority of Athletes Pass Symmetry Criteria in a Series of Hop and Strength Tests Irrespective of Having an ACL Reconstructed Knee or Being Noninjured. Sports Health: A Multidisciplinary Approach. 2023;15(1):45-51. doi:10.1177/19417381221097949 [Google Scholar] [Crossref]

29. Farmer B, Anderson D, Katsavelis D, Bagwell JJ, Turman KA, Grindstaff TL. Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction. J Orthop Res. 2022 Jan;40(1):200-207. doi: 10.1002/jor.25073. [Google Scholar] [Crossref]

30. Kotsifaki A, Van Rossom S, Whiteley R, et al. Between-Limb Symmetry in ACL and Tibiofemoral Contact Forces in Athletes After ACL Reconstruction and Clearance for Return to Sport. Orthopaedic Journal of Sports Medicine. 2022;10(4). doi:10.1177/23259671221084742 [Google Scholar] [Crossref]

31. Arhos EK, Smith AH, Ito N, Risberg MA, Snyder-Mackler L, Silbernagel KG. Use of the Uninvolved Limb as Comparator When Calculating Return to Sports Hop Test Symmetry After ACL Reconstruction. Sports Health: A Multidisciplinary Approach. 2026;18(1):118-124. doi:10.1177/19417381251334639 [Google Scholar] [Crossref]

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