The Relationship Between ACL Injury and Sports Performance of Basketball Players

Research Article
Open access

The Relationship Between ACL Injury and Sports Performance of Basketball Players

Jingquan Zhang 1*
  • 1 School of Physical Education, Huazhong University of Science and Technology, Wuhan, China    
  • *corresponding author m202475614@hust.edu.cn
TNS Vol.113
ISSN (Print): 2753-8826
ISSN (Online): 2753-8818
ISBN (Print): 978-1-80590-161-7
ISBN (Online): 978-1-80590-162-4

Abstract

Anterior cruciate ligament (ACL) injuries are common and serious musculoskeletal injuries in basketball players, with significant impact on both performance and career. Basketball players are particularly susceptible to ACL ruptures, primarily through non-contact mechanisms, due to the frequent high-impact movements involved in the sport, such as rapid changes of direction, deceleration, and unstable landings. Recent evidence suggests that anatomical factors such as narrow intercondylar femoral notch width, increased posterior tibial tilt, and shortened ACL length are important factors in the risk of ACL injury. Clinical diagnosis of ACL injury is usually performed with a combination of manual examination and magnetic resonance imaging (MRI), and surgical reconstruction remains the standard of care to restore knee function to athletes. Postoperative outcomes depend largely on a systematic, long-term rehabilitation strategy aimed at improving muscle strength, neuromuscular control, and limb symmetry. In addition, psychological factors—particularly fear of re-injury and decreased self-efficacy—can significantly impact an athlete's ability to successfully return to competitive play. This article systematically reviews the epidemiological characteristics, anatomical risk factors of lower limbs, injury mechanisms, and diagnosis and rehabilitation strategies of ACL injuries. It focuses on the innovative perspective of quantitative analysis of the anatomical risk factors of ACL injuries in basketball players based on high-quality English literature in the past five years, and deeply discusses the impact of ACL injuries on the short-term and long-term sports performance of basketball players.

Keywords:

ACL injury, basketball athletes, anatomical risk factors, rehabilitation strategies, return to sport

Zhang,J. (2025). The Relationship Between ACL Injury and Sports Performance of Basketball Players. Theoretical and Natural Science,113,26-40.
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References

[1]. Mancino F, Kayani B, Gabr A, Fontalis A, Plastow R, Haddad FS. Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention. Bone Jt Open. 2024;5(2):94-100. doi:10.1302/2633-1462.52.BJO-2023-0166

[2]. Stojanović E, Faude O, Nikić M, Scanlan AT, Radovanović D, Jakovljević V. The incidence rate of ACL injuries and ankle sprains in basketball players: A systematic review and meta-analysis. Scand J Med Sci Sports. 2023 Jun;33(6):790-813. doi: 10.1111/sms.14328. Epub 2023 Feb 19. PMID: 36752659.

[3]. Corewell Health. ACL Tears. Sports Injuries | Anterior Cruciate Ligament (ACL) Tears | Corewell Health

[4]. Wheeless’ Textbook of Orthopaedics. ACL Epidemiology. ACL Epidemiology : Wheeless' Textbook of Orthopaedics

[5]. Thayaparan A, Kantharuban S (August 27, 2024) Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments. Cureus 16(8): e67956. doi:10.7759/cureus.67956

[6]. Shambaugh, J. P., Klein, A., & Herbert, J. H. (1991). Structural measures as predictors of injury basketball players. Medicine and science in sports and exercise, 23(5), 522–527.

[7]. Stijak, L., Herzog, R. F., & Schai, P. (2008). Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 16(2), 112–117. https://doi.org/10.1007/s00167-007-0438-1

[8]. Souryal, T. O., & Freeman, T. R. (1993). Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. The American journal of sports medicine, 21(4), 535–539. https://doi.org/10.1177/036354659302100410

[9]. Myer, G. D., Ford, K. R., Paterno, M. V., Nick, T. G., & Hewett, T. E. (2008). The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. The American journal of sports medicine, 36(6), 1073–1080. https://doi.org/10.1177/0363546507313572

[10]. Nakase, J., Kitaoka, K., Shima, Y., Oshima, T., Sakurai, G., & Tsuchiya, H. (2020). Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 22, 34–38. https://doi.org/10.1016/j.asmart.2020.06.002

[11]. Li, Z., Li, C., Li, L., & Wang, P. (2020). Correlation between notch width index assessed via magnetic resonance imaging and risk of anterior cruciate ligament injury: an updated meta-analysis. Surgical and radiologic anatomy: SRA, 42(10), 1209–1217. https://doi.org/10.1007/s00276-020-02496-6

[12]. Hohmann, E., Tetsworth, K., Glatt, V., Ngcelwane, M., & Keough, N. (2021). Medial and Lateral Posterior Tibial Slope Are Independent Risk Factors for Noncontact ACL Injury in Both Men and Women. Orthopaedic journal of sports medicine, 9(8), 23259671211015940. https://doi.org/10.1177/23259671211015940

[13]. Gupta, R., Jhatiwal, S., Kapoor, A., Kaur, R., Soni, A., & Singhal, A. (2022). Narrow Notch Width and Low Anterior Cruciate Ligament Volume Are Risk Factors for Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging-Based Study. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 18(3), 376–384. https://doi.org/10.1177/15563316211041090

[14]. Gültekin, M. Z., Dinçel, Y. M., Keskin, Z., Arslan, S., & Yıldırım, A. (2023). Morphometric risk factors effects on anterior cruciate ligament injury. Joint diseases and related surgery, 34(1), 130–137. https://doi.org/10.52312/jdrs.2023.910

[15]. Tosarelli F, Buckthorpe M, Di Paolo S, Grassi A, Rodas G, Zaffagnini S, Nanni G, Della Villa F. Video Analysis of Anterior Cruciate Ligament Injuries in Male Professional Basketball Players: Injury Mechanisms, Situational Patterns, and Biomechanics. Orthop J Sports Med. 2024 Mar 22;12(3):23259671241234880. doi: 10.1177/23259671241234880. PMID: 38524890; PMCID: PMC10960353.

[16]. Maniar N, Cole MH, Bryant AL, Opar DA. Muscle Force Contributions to Anterior Cruciate Ligament Loading. Sports Med. 2022 Aug;52(8):1737-1750. doi: 10.1007/s40279-022-01674-3. Epub 2022 Apr 18. PMID: 35437711; PMCID: PMC9325827.

[17]. DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. Am J Sports Med. 2004 Mar;32(2):477-83. doi: 10.1177/0363546503258928. PMID: 14977677.

[18]. Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med. 2023 Nov;57(21):1395-1399. doi: 10.1136/bjsports-2023-107075. Epub 2023 Aug 30. PMID: 37648410.

[19]. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492-501

[20]. Busfield BT, Kharrazi FD, Starkey C, Lombardo SJ, Seegmiller J. Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association. Arthroscopy. 2009; 25: 825-830

[21]. Liu SH, Osti L, Henry M, Bocchi L. The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br. 1995 Jul;77(4):586-8. PMID: 7615603.

[22]. Valsalam P, Sha I I, Edwin A. Lever Test: Role of Its Assistance in Diagnosis of Anterior Cruciate Ligament Injury. JROS 2020; 7 (3) :115-120

[23]. Wikem. Segond fracture. Segond fracture – WikEM

[24]. Zhao M, Zhou Y, Chang J, Hu J, Liu H, Wang S, Si D, Yuan Y, Li H. The accuracy of MRI in the diagnosis of anterior cruciate ligament injury. Ann Transl Med. 2020 Dec;8(24):1657. doi: 10.21037/atm-20-7391. PMID: 33490169; PMCID: PMC7812197.

[25]. Okoroha, K.R., Haunschild, E.D., Gilat, R., Cole, B. (2020). Management of ACL Injuries in Basketball. In: Laver, L., Kocaoglu, B., Cole, B., Arundale, A.J.H., Bytomski, J., Amendola, A. (eds) Basketball Sports Medicine and Science. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61070-1_30

[26]. Zhao L, Lu M, Deng M, Xing J, He L, Wang C. Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up. Medicine (Baltimore). 2020 Nov 25;99(48):e23476. doi: 10.1097/MD.0000000000023476. Erratum in: Medicine (Baltimore). 2022 Aug 26;101(34):e29873. doi: 10.1097/MD.0000000000029873. PMID: 33235137; PMCID: PMC7710199.

[27]. DeFroda SF, Patel DD, Milner J, Yang DS, Owens BD. Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Orthop J Sports Med. 2021 Feb 26;9(2):2325967120981649. doi: 10.1177/2325967120981649. PMID: 33738307; PMCID: PMC7934048.

[28]. Harris JD, Erickson BJ, Bach BR Jr, Abrams GD, Cvetanovich GL, Forsythe B, McCormick FM, Gupta AK, Cole BJ. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Sports Health. 2013 Nov;5(6):562-8. doi: 10.1177/1941738113495788. PMID: 24427434; PMCID: PMC3806178.

[29]. Beischer S, Gustavsson L, Senorski EH, Karlsson J, Thomeé C, Samuelsson K, Thomeé R. Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. J Orthop Sports Phys Ther. 2020 Feb;50(2):83-90. doi: 10.2519/jospt.2020.9071. Erratum in: J Orthop Sports Phys Ther. 2020 Jul;50(7):411. doi: 10.2519/jospt.2020.50.7.411. PMID: 32005095.

[30]. Welling W, Benjaminse A, Seil R, Lemmink K, Zaffagnini S, Gokeler A. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3636-3644. doi: 10.1007/s00167-018-4916-4. Epub 2018 Mar 24. PMID: 29574548; PMCID: PMC6267144.

[31]. Lepley LK. Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction: A Review of the Current Literature. Sports Health. 2015 May;7(3):231-8. doi: 10.1177/1941738115578112. PMID: 26131300; PMCID: PMC4482305.

[32]. Liew, B. X. W., Feller, J. A., & Webster, K. E. (2022). Understanding the psychological mechanisms of return to sports readiness after anterior cruciate ligament reconstruction. PloS one, 17(3), e0266029. https://doi.org/10.1371/journal.pone.0266029

[33]. Ardern, C.L.; Taylor, N.F.; Feller, J.A.; Webster, K.E. Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J. Sci. Med. Sport 2012, 15, 488–495.

[34]. Longo, U. G., De Salvatore, S., D’Orrico, F., Bella, M., Corradini, A., Rizzello, G., De Marinis, M. G., & Denaro, V. (2023). The Impact of Psychological Factors on Return to Sports after Anterior Cruciate Ligament Reconstruction: A Systematic Review. Osteology, 3(3), 78-93. https://doi.org/10.3390/osteology3030009

[35]. Piussi, R.; Beischer, S.; Thomeé, R.; Senorski, E.H. Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 555–567.

[36]. Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruc tion with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):1021–8.

[37]. Shakespeare DT, Stokes M, Sherman KP, Young A. Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain. Clin Physiol. 1985;5(2):137–144. doi: 10.1111/j.1475-097x.1985.tb00589.x.

[38]. Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:302-311.

[39]. Thomas, A. C., Villwock, M., Wojtys, E. M., & Palmieri-Smith, R. M. (2013). Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. Journal of athletic training, 48(5), 610–620. https://doi.org/10.4085/1062-6050-48.3.23

[40]. Elias JJ, Faust AF, Chu YH, Chao EY, Cosgarea AJ. The soleus muscle acts as an agonist for the anterior cruciate ligament. An in vitro experimental study. Am J Sports Med. 2003 Mar-Apr;31(2):241-6. doi: 10.1177/03635465030310021401. PMID: 12642259.


Cite this article

Zhang,J. (2025). The Relationship Between ACL Injury and Sports Performance of Basketball Players. Theoretical and Natural Science,113,26-40.

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The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

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Volume title: Proceedings of ICBioMed 2025 Symposium: AI for Healthcare: Advanced Medical Data Analytics and Smart Rehabilitation

ISBN:978-1-80590-161-7(Print) / 978-1-80590-162-4(Online)
Editor:Alan Wang
Conference date: 17 October 2025
Series: Theoretical and Natural Science
Volume number: Vol.113
ISSN:2753-8818(Print) / 2753-8826(Online)

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References

[1]. Mancino F, Kayani B, Gabr A, Fontalis A, Plastow R, Haddad FS. Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention. Bone Jt Open. 2024;5(2):94-100. doi:10.1302/2633-1462.52.BJO-2023-0166

[2]. Stojanović E, Faude O, Nikić M, Scanlan AT, Radovanović D, Jakovljević V. The incidence rate of ACL injuries and ankle sprains in basketball players: A systematic review and meta-analysis. Scand J Med Sci Sports. 2023 Jun;33(6):790-813. doi: 10.1111/sms.14328. Epub 2023 Feb 19. PMID: 36752659.

[3]. Corewell Health. ACL Tears. Sports Injuries | Anterior Cruciate Ligament (ACL) Tears | Corewell Health

[4]. Wheeless’ Textbook of Orthopaedics. ACL Epidemiology. ACL Epidemiology : Wheeless' Textbook of Orthopaedics

[5]. Thayaparan A, Kantharuban S (August 27, 2024) Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments. Cureus 16(8): e67956. doi:10.7759/cureus.67956

[6]. Shambaugh, J. P., Klein, A., & Herbert, J. H. (1991). Structural measures as predictors of injury basketball players. Medicine and science in sports and exercise, 23(5), 522–527.

[7]. Stijak, L., Herzog, R. F., & Schai, P. (2008). Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 16(2), 112–117. https://doi.org/10.1007/s00167-007-0438-1

[8]. Souryal, T. O., & Freeman, T. R. (1993). Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. The American journal of sports medicine, 21(4), 535–539. https://doi.org/10.1177/036354659302100410

[9]. Myer, G. D., Ford, K. R., Paterno, M. V., Nick, T. G., & Hewett, T. E. (2008). The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. The American journal of sports medicine, 36(6), 1073–1080. https://doi.org/10.1177/0363546507313572

[10]. Nakase, J., Kitaoka, K., Shima, Y., Oshima, T., Sakurai, G., & Tsuchiya, H. (2020). Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 22, 34–38. https://doi.org/10.1016/j.asmart.2020.06.002

[11]. Li, Z., Li, C., Li, L., & Wang, P. (2020). Correlation between notch width index assessed via magnetic resonance imaging and risk of anterior cruciate ligament injury: an updated meta-analysis. Surgical and radiologic anatomy: SRA, 42(10), 1209–1217. https://doi.org/10.1007/s00276-020-02496-6

[12]. Hohmann, E., Tetsworth, K., Glatt, V., Ngcelwane, M., & Keough, N. (2021). Medial and Lateral Posterior Tibial Slope Are Independent Risk Factors for Noncontact ACL Injury in Both Men and Women. Orthopaedic journal of sports medicine, 9(8), 23259671211015940. https://doi.org/10.1177/23259671211015940

[13]. Gupta, R., Jhatiwal, S., Kapoor, A., Kaur, R., Soni, A., & Singhal, A. (2022). Narrow Notch Width and Low Anterior Cruciate Ligament Volume Are Risk Factors for Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging-Based Study. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 18(3), 376–384. https://doi.org/10.1177/15563316211041090

[14]. Gültekin, M. Z., Dinçel, Y. M., Keskin, Z., Arslan, S., & Yıldırım, A. (2023). Morphometric risk factors effects on anterior cruciate ligament injury. Joint diseases and related surgery, 34(1), 130–137. https://doi.org/10.52312/jdrs.2023.910

[15]. Tosarelli F, Buckthorpe M, Di Paolo S, Grassi A, Rodas G, Zaffagnini S, Nanni G, Della Villa F. Video Analysis of Anterior Cruciate Ligament Injuries in Male Professional Basketball Players: Injury Mechanisms, Situational Patterns, and Biomechanics. Orthop J Sports Med. 2024 Mar 22;12(3):23259671241234880. doi: 10.1177/23259671241234880. PMID: 38524890; PMCID: PMC10960353.

[16]. Maniar N, Cole MH, Bryant AL, Opar DA. Muscle Force Contributions to Anterior Cruciate Ligament Loading. Sports Med. 2022 Aug;52(8):1737-1750. doi: 10.1007/s40279-022-01674-3. Epub 2022 Apr 18. PMID: 35437711; PMCID: PMC9325827.

[17]. DeMorat G, Weinhold P, Blackburn T, Chudik S, Garrett W. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury. Am J Sports Med. 2004 Mar;32(2):477-83. doi: 10.1177/0363546503258928. PMID: 14977677.

[18]. Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med. 2023 Nov;57(21):1395-1399. doi: 10.1136/bjsports-2023-107075. Epub 2023 Aug 30. PMID: 37648410.

[19]. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492-501

[20]. Busfield BT, Kharrazi FD, Starkey C, Lombardo SJ, Seegmiller J. Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association. Arthroscopy. 2009; 25: 825-830

[21]. Liu SH, Osti L, Henry M, Bocchi L. The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br. 1995 Jul;77(4):586-8. PMID: 7615603.

[22]. Valsalam P, Sha I I, Edwin A. Lever Test: Role of Its Assistance in Diagnosis of Anterior Cruciate Ligament Injury. JROS 2020; 7 (3) :115-120

[23]. Wikem. Segond fracture. Segond fracture – WikEM

[24]. Zhao M, Zhou Y, Chang J, Hu J, Liu H, Wang S, Si D, Yuan Y, Li H. The accuracy of MRI in the diagnosis of anterior cruciate ligament injury. Ann Transl Med. 2020 Dec;8(24):1657. doi: 10.21037/atm-20-7391. PMID: 33490169; PMCID: PMC7812197.

[25]. Okoroha, K.R., Haunschild, E.D., Gilat, R., Cole, B. (2020). Management of ACL Injuries in Basketball. In: Laver, L., Kocaoglu, B., Cole, B., Arundale, A.J.H., Bytomski, J., Amendola, A. (eds) Basketball Sports Medicine and Science. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61070-1_30

[26]. Zhao L, Lu M, Deng M, Xing J, He L, Wang C. Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up. Medicine (Baltimore). 2020 Nov 25;99(48):e23476. doi: 10.1097/MD.0000000000023476. Erratum in: Medicine (Baltimore). 2022 Aug 26;101(34):e29873. doi: 10.1097/MD.0000000000029873. PMID: 33235137; PMCID: PMC7710199.

[27]. DeFroda SF, Patel DD, Milner J, Yang DS, Owens BD. Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Orthop J Sports Med. 2021 Feb 26;9(2):2325967120981649. doi: 10.1177/2325967120981649. PMID: 33738307; PMCID: PMC7934048.

[28]. Harris JD, Erickson BJ, Bach BR Jr, Abrams GD, Cvetanovich GL, Forsythe B, McCormick FM, Gupta AK, Cole BJ. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Sports Health. 2013 Nov;5(6):562-8. doi: 10.1177/1941738113495788. PMID: 24427434; PMCID: PMC3806178.

[29]. Beischer S, Gustavsson L, Senorski EH, Karlsson J, Thomeé C, Samuelsson K, Thomeé R. Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. J Orthop Sports Phys Ther. 2020 Feb;50(2):83-90. doi: 10.2519/jospt.2020.9071. Erratum in: J Orthop Sports Phys Ther. 2020 Jul;50(7):411. doi: 10.2519/jospt.2020.50.7.411. PMID: 32005095.

[30]. Welling W, Benjaminse A, Seil R, Lemmink K, Zaffagnini S, Gokeler A. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3636-3644. doi: 10.1007/s00167-018-4916-4. Epub 2018 Mar 24. PMID: 29574548; PMCID: PMC6267144.

[31]. Lepley LK. Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction: A Review of the Current Literature. Sports Health. 2015 May;7(3):231-8. doi: 10.1177/1941738115578112. PMID: 26131300; PMCID: PMC4482305.

[32]. Liew, B. X. W., Feller, J. A., & Webster, K. E. (2022). Understanding the psychological mechanisms of return to sports readiness after anterior cruciate ligament reconstruction. PloS one, 17(3), e0266029. https://doi.org/10.1371/journal.pone.0266029

[33]. Ardern, C.L.; Taylor, N.F.; Feller, J.A.; Webster, K.E. Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J. Sci. Med. Sport 2012, 15, 488–495.

[34]. Longo, U. G., De Salvatore, S., D’Orrico, F., Bella, M., Corradini, A., Rizzello, G., De Marinis, M. G., & Denaro, V. (2023). The Impact of Psychological Factors on Return to Sports after Anterior Cruciate Ligament Reconstruction: A Systematic Review. Osteology, 3(3), 78-93. https://doi.org/10.3390/osteology3030009

[35]. Piussi, R.; Beischer, S.; Thomeé, R.; Senorski, E.H. Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 2020, 28, 555–567.

[36]. Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruc tion with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):1021–8.

[37]. Shakespeare DT, Stokes M, Sherman KP, Young A. Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain. Clin Physiol. 1985;5(2):137–144. doi: 10.1111/j.1475-097x.1985.tb00589.x.

[38]. Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:302-311.

[39]. Thomas, A. C., Villwock, M., Wojtys, E. M., & Palmieri-Smith, R. M. (2013). Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. Journal of athletic training, 48(5), 610–620. https://doi.org/10.4085/1062-6050-48.3.23

[40]. Elias JJ, Faust AF, Chu YH, Chao EY, Cosgarea AJ. The soleus muscle acts as an agonist for the anterior cruciate ligament. An in vitro experimental study. Am J Sports Med. 2003 Mar-Apr;31(2):241-6. doi: 10.1177/03635465030310021401. PMID: 12642259.