Fatores prognósticos associados ao retorno ao esporte após tratamento não cirúrgico da lesão do ligamento cruzado anterior: revisão sistemática

Anterior cruciate ligament (ACL) injury may be initially managed with nonsurgical rehabilitation in selected individuals, but return-to-sport (RTS) outcomes are heterogeneous. This systematic review aimed to identify and analyse clinical, functional, demographic, sport-related and psychosocial factors associated with RTS after non-surgical management of ACL injury. The research process and preliminary literature survey began in June 2026. Formal electronic searches were conducted in September 2026, while complementary reference tracking, additional checks and the final update continued until October 6, 2026, when the bibliographic update for this review was concluded. The review was not prospectively registered. The main searches were performed in PubMed/MEDLINE and SciELO and were complemented by reference tracking, backward citation searching and additional checks. After deduplication, 1,761 unique records remained from the main databases; an additional 31 records or reports were identified through other methods and retained in a separate PRISMA pathway. Thirteen reports from databases and eight reports from other methods underwent detailed eligibility assessment. Eleven reports representing eight independent studies or cohorts were included. Risk of bias was assessed using QUIPS, and a narrative synthesis was conducted because of clinical and methodological heterogeneity. Better self-reported knee function at six months provided the most direct temporal prognostic evidence for RTS at 12 months. Quadriceps and hamstring strength, knee stability, functional performance and psychological readiness were also associated with RTS or sport participation, although several associations were concurrent with the outcome. Higher preinjury sport demand was associated with lower RTS in one study, with potential influence from activity-modification advice. Coper/noncoper classification rules showed clinical stratification potential but limited prognostic accuracy. RTS after non-surgical ACL management is therefore multifactorial, and current evidence does not support using a single test or isolated characteristic to predict return.