فهرست نشریات علمی دسترسی آزاد ایران

Introduction: Achieving a successful return to sport after anterior cruciate ligament reconstruction remains a significant challenge. Despite high patient expectations, only about 55% of athletes return to competitive sports, and up to 20% of those suffer a second ACL injury. Although various RTS test batteries have been developed to assess readiness and reduce re-injury risk, many athletes fail to meet these criteria, and passing them does not consistently prevent re-injury, indicating limited predictive validity. This narrative review critically evaluates RTS testing, rehabilitation quality, and the RTS continuum from a holistic perspective over the past 15 years.Methods: This narrative review synthesizes literature from the past 15 years, focusing on three core areas: 1) RTS testing protocols and their limitations, 2) the structure, content, and quality of rehabilitation programs, and 3) the dynamic and individualized nature of the RTS continuum.Results: Current RTS test batteries, while multidimensional, lack ecological validity and fail to reliably predict re-injury. Rehabilitation programs often underprepare athletes for sport-specific demands due to insufficient loading, lack of neurocognitive integration, and inadequate on-field progression. Psychological readiness, influenced by fear of re-injury and communication styles, is a critical yet often overlooked component. A holistic, individualized approach incorporating progressive strength training, external focus instruction, neurocognitive challenges, and on-field rehabilitation is essential for improving RTS outcomes. The RTS continuum model (OFR, RTT, RTC, RTP) emphasizes phased reintegration, supported by shared decision-making and ongoing monitoring.Conclusion: RTS after ACLR is a complex, individualized process. Enhancing RTS success requires ecologically valid testing, high-quality progressive rehabilitation, psychological support, neurocognitive training, and structured on-field progression. Future efforts should prioritize personalized rehabilitation strategies and long-term secondary prevention to ensure safer and more effective returns to sport.