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Anterior cruciate ligament (ACL) rupture is the most serious injury in judo. However, little is known about the outcome of treatment and its impact on subsequent athletic development. This study aimed to evaluate (1) ACL re-injury rates, injury-related time loss, and (2) regained level of performance in judoka after conservatively and surgically treated ACL ruptures.Five hundred judoka who had suffered an ACL rupture were included in the study via an online survey. Re-injury rates, persistent symptoms, time loss, and reduction in athletic performance were assessed according to performance level and treatment approach (surgical vs. conservative).Eighty-six percent of athletes underwent surgery. The overall re-injury rate was 27.6%. In the highest performance level group, 41.4% sustained a re-injury. No significant difference was observed with regard to persistent pain, swelling, and episodes of instability (surgical vs. conservative: pain 40.1% vs. 35.2%, p=0.436; swelling 21.7% vs. 12.7%, p=0.081; instability 14.0% vs. 15.5% p=0.736) Among conservatively treated patients, 70.4% returned to sport after 6 months, whereas among surgically treatment patients, 35.9% returned within 6-9 months and 33.6% after more than 9 months . There was no significant difference in post-injury performance level between treatment groups (same performance level: surgical 32% vs. conservative 35%).Judo athletes show high re-injury rates after ACL ruptures, especially in high performance classes. The proportion of persistent symptoms after surgical therapy is high and differs only slightly from those treated conservatively. In rare cases, pre-injury performance levels may be regained even after conservative therapy.