Return to Sport Post ACL Injury: General Issues
Guidelines and testing for safe return to sports and activities.
Beyond Time-Based Criteria
Modern return-to-sport guidelines have moved away from strictly time-based criteria toward a comprehensive assessment approach. Most experts now recommend that athletes:
- Wait a minimum of 9-12 months after surgery (biological healing time)
- Pass a battery of functional and strength tests
- Demonstrate sport-specific competence
- Show psychological readiness
Strength and Symmetry Testing
Objective measurements help assess readiness:
- Strength testing: Typically aiming for ≥90% strength in the surgical leg compared to the uninjured leg
- Common assessments:
- Isokinetic testing of quadriceps and hamstrings
- Hand-held dynamometer measurements
- Hamstring-to-quadriceps ratio evaluation
Functional Testing
Performance-based tests evaluate movement quality and function:
- Single-leg hop tests: Battery typically includes:
- Single hop for distance
- Triple hop for distance
- Triple crossover hop
- 6-meter timed hop
- Jump landing assessments: Evaluating mechanics during drop vertical jump and other tasks
- Movement quality screening: Including assessment of valgus collapse, trunk control, and other high-risk movement patterns
- Agility testing: Sport-specific change of direction and reaction time tests
Psychological Readiness
Mental factors are increasingly recognized as critical:
- Assessment tools: Including the ACL-Return to Sport after Injury (ACL-RSI) scale and Tampa Scale for Kinesiophobia
- Key factors: Confidence in the knee, fear of re-injury, anxiety during sport-specific movements, and motivation
- Interventions: Including visualization, graded exposure to anxiety-provoking situations, and sport psychology consultation when needed
Graduated Return Protocol
A phased approach is recommended for safe return:
- Return to practice without contact
- Return to practice with limited contact
- Return to full practice
- Limited game participation
- Full unrestricted return
See Also:
Web Articles on Returning to Sport After ACL Surgery
- Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction?
- ACL Rehabilitation: Re-injury and Return to Sport Tests
- Return to Sport After ACL Reconstruction Surgery
- Return to Play to Pre-Injury Level Following Anterior Cruciate Ligament Injury (Paper from The American Academy of Orthopaedic Surgeons Board of Directors)
YouTube Videos on ACL Recovery & Return to Sport
- When Can You Return To Sport Following ACL Surgery? | Expert Physio Reviews The Evidence
- When Can You Return to Sports After #ACL Surgery with Dr. Bill Sterett
- How To Return Back To Sport After An Injury (ACL, Meniscus, MCL, Ankle Sprain)
- The Healing Process of the ACL Graft
- Your Brain Impacts ACL Surgery Recovery
- Why does it take so long to recover from an ACL injury?
- How long does it take to recovery from ACL surgery?
- What are the risks of ACL surgery?
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