Return to Sport After Acromioclavicular Injury: A Systematic Review of Modifiable Factors

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Science

Background:

• Acromioclavicular joint (ACJ) injuries are prevalent in athletes, often leading to significant time away from competition.
• While functional recovery is documented, return to sport (RTS) metrics and the impact of various treatment strategies remain unclear.

Purpose of the Study:

• To systematically review current literature on return to sport (RTS) outcomes following acromioclavicular joint (ACJ) injuries in athletes.
• To analyze the influence of treatment modality, surgical technique, and rehabilitation protocols on RTS rates and time.

Main Methods:

• A PRISMA-guided systematic review of studies published between 2015-2025 was performed across major databases (PubMed, Embase, Scopus, Web of Science, Cochrane).
• Studies reporting RTS metrics (time, rate, return to pre-injury level) after ACJ injury were included, with data extraction on injury type, treatment, and rehabilitation.

Main Results:

• Twenty-five studies involving 1077 patients reported a pooled RTS rate of 90.8%, with 87.7% returning to their pre-injury level.
• Non-operative treatment yielded faster RTS (52 days) than operative management (127 days).
• Early strengthening protocols (within 6 weeks) were associated with faster RTS (93 days) and higher pre-injury RTS rates (86.8%).

Conclusions:

• High rates of return to sport are achievable following ACJ injuries, irrespective of treatment approach.
• Trends suggest earlier surgery, allograft reconstruction, and early rehabilitation may enhance RTS outcomes, but require cautious interpretation due to study heterogeneity.
• Standardized RTS definitions and prospective studies are crucial for clarifying optimal management strategies.