Bridge builder between research, clinical practice and sports.

You will find below a summary of Yana Feller's Master thesis from the 'Technische Universitat München Fakultät für Sport- und Gesundheitswisssenschaften'

From Trauma to Rehabilitation: How Can Elite Volleyball Players Safely Return to Training After an ACL Injury?

An anterior cruciate ligament (ACL) tear is among the most severe injuries in competitive sports. Volleyball athletes are particularly affected, as the sport demands frequent jumping, abrupt landings, and rapid changes of direction. The consequences are far-reaching: long recovery times, psychological strain, and an elevated risk of subsequent injuries. This complex journey back to the court was the central focus of a study that examined how athletes can safely return to training and competition after an ACL rupture.

The ACL, whether anterior or posterior, plays a crucial role in knee stability. It prevents dislocations, controls rotational movements, and, through embedded receptors, provides vital information for muscular coordination. The consequences of a torn ligament are therefore severe. Diagnosis is typically based on clinical tests such as the Lachman or Pivot-shift test, complemented by imaging techniques like MRI. ACL tears often occur alongside other injuries, for instance to the meniscus or collateral ligaments.

The causes can vary. For young female athletes, hormonal factors and anatomical structures such as a steeper tibial plateau slope play a role, while for men, intensity of load and technique are more influential. Further aspects such as hall floor and footwear also contribute. Interestingly, most injuries occur during competition rather than during training, largely due to higher intensity and stress. Women are affected more frequently overall, which is attributed primarily to hormonal and anatomical differences.

Successful treatment involves multiple dimensions. While conservative approaches aim to restore stability through muscle strengthening, surgery remains the standard for elite athletes. ACL reconstruction is widely established, though newer techniques such as internal bracing are rising. Regardless of the method chosen, rehabilitation is decisive. It progresses through phases: restoring mobility, building strength, training coordination, and finally reintegrating sport-specific movements. For volleyball players, this means targeted jump and landing drills, block and attack simulations, and gradually returning to game-like situations. Nutrition also plays an important role—adequate protein supports muscle building, while vitamin C and omega-3 fatty acids promote healing. Preventive programs such as FIFA 11+ or plyometric exercises have been shown to significantly reduce the risk of re-injury.

A study I conducted with 45 elite volleyball players highlights the significance of this issue. The average age at the first injury was just 19.5 years—a stage when many athletes are only beginning to advance into higher leagues. Most injuries occurred in competition, typically without contact from opponents, and almost always during landings after attacks or blocks. Around 87% opted for surgery after their first rupture, but many required further procedures. Accompanying injuries were also frequent: 80% had additional damage to the meniscus or collateral ligaments.

Rehabilitation outcomes varied widely. While some players returned to the court after six to nine months, others needed over a year. Four athletes had to end their careers entirely. Even after completing rehabilitation, 78% still reported pain, restricted mobility, or instability in the knee. Only a small minority sought psychological support, though the mental burden was frequently described as particularly high.

The findings make clear that a safe return to volleyball training can only be achieved through a holistic approach. This includes individually tailored rehab plans, regular performance assessments, targeted prevention programs, and psychological support. The decision to resume training should not be based solely on elapsed time but on objective criteria such as strength, stability, movement quality, and mental readiness.

In conclusion, ACL ruptures represent not only a medical issue but also a sporting and psychological challenge. Long-term athletic performance requires an integrated approach combining medicine, physiotherapy, training, prevention, and mental coaching. Only such a comprehensive strategy ensures that athletes can return to the court not just quickly, but above all safely.