Elite Soccer Players After ACL Reconstruction: An Updated Bibliometric Analysis of Return-to-Play Assessment Technologies

Abstract

Anterior cruciate ligament reconstruction (ACLR) remains one of the most frequent career-altering surgical interventions in elite soccer, and the decision to clear an athlete for return to play (RTP) is increasingly framed as a criterion-based, multidimensional process integrating strength, biomechanics, sport-specific performance, and psychological readiness. The literature on assessment technologies supporting this process has expanded rapidly, but no bibliometric synthesis has been updated to reflect the surge of consensus statements, large registry-based studies, and machine-learning applications that have appeared in 2025 and early 2026. To update and extend a previous bibliometric mapping of the scientific production, intellectual structure, and thematic trajectory of research on RTP assessment technologies in elite soccer players after ACLR for the period 2005–April 2026, and to characterize the emerging methodological frontier. Following PRISMA 2020 guidance for bibliometric searches, Web of Science Core Collection, Scopus, PubMed, and SPORTDiscus were searched on 30 April 2026 with no lower limit on publication year. Ninety-two studies were retained for descriptive bibliometrics with the Bibliometrix R-package 4.3, keyword co-occurrence mapping with VOSviewer 1.6.20, and burst-detection with CiteSpace 6.3.R1. Annual production, leading countries, journals, co-occurrence of author keywords, and the distribution of assessment technologies were quantified. Annual production grew from 1 article in 2005 to a projected 22 in 2025, with publication volume in the first four months of 2026 (n = 8) already on pace to set a new annual record. Approximately 78% of the records were published after 2015 and 28% after 2023, reflecting a marked post-pandemic acceleration. The United States, Italy, and Norway retained leadership, while the United Kingdom, Qatar, and Germany strengthened their positions through Premier-League-based video-analysis cohorts and the FIFPRO Project ACL consortium. The American Journal of Sports Medicine, the British Journal of Sports Medicine, and Knee Surgery, Sports Traumatology, Arthroscopy remained the most prolific outlets. Isokinetic dynamometry (19%), hop-test batteries (16%), force-plate jump assessment (14%), and three-dimensional motion capture (12%) continued to dominate, while inertial measurement units (IMUs), GPS-tracked field load, ACL-RSI, and machine-learning–derived movement classifiers were the fastest-growing methods after 2022. Research on RTP assessment in elite-soccer ACLR has consolidated around a hybrid, technology-supported model that integrates laboratory-based strength and biomechanics, on-field load and kinematics monitoring, validated psychological readiness instruments, and—most recently—artificial-intelligence–assisted decision support. Future work should prioritise harmonisation of test batteries, prospective validation against reinjury and performance outcomes, sex-specific reference values, and ecological wearable-based monitoring throughout the return-to-performance continuum.