Examining Return to Play Protocols for ACL Injuries using the International Classification of Functioning, Disability, and Health (ICF): A Rapid Review

Abstract

Purpose Anterior cruciate ligament (ACL) injuries are a common occurrence, especially in sports. These injuries require a comprehensive return-to-play (RTP) protocol that is suited for the individual. This review aims to assess existing RTP protocols for ACL injuries, using the WHO’s International Classification of Functioning, Disability, and Health (ICF) framework. The objective is to identify trends and gaps in RTP protocols based on the domains of the ICF framework. Methods A rapid review was conducted from the following databases: Embase, MEDLINE, and CENTRAL. Studies were screened using Covidence and reviewed using National Collaborating Centre for Methods and Tools (NCCMT) guidelines. The analysis examined the included return-to-play protocols and assessed them through the lens of the ICF framework. Results Fifteen studies were included in the review. Based on the protocols of the included studies, three key trends were observed: 1) Focus on functioning and disability rather than contextual factors, 2) Player’s psychological needs are considered in only a few studies (n = 4), and 3) Most return-to-play protocols were fairly rigid. Conclusion This review highlights key trends and gaps in existing RTP protocols for ACL injuries. The protocols can be improved by aligning themselves with the ICF, specifically through the inclusion of environmental and personal factors. This could potentially pave the way for a standardized ACL RTP protocol. Level of Evidence: II