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ACL Rehabilitation: When To Return To Sport?

Many athletes understand that it may take roughly 6-9 months to rehabilitate from an ACL reconstruction.

(Examples: Adrian Peterson, professional football player for the Minnesota Vikings; Lindsey Vonn, American World Cup Alpine Ski Racer for the US Ski Team; Jabari Parker, professional basketball player for the Milwaukee Bucks.)

Traditionally, it is the orthopedic surgeon who performed the surgery that gives the final clearance to the patient on when they can return to their sport. What tests and physical examination procedures are performed to dictate the athlete’s “readiness” to play again?

In a recent review of literature by Barber-Westin and Noyes, the authors reported that decisions on return to sport after anterior cruciate ligament (ACL) reconstruction included the combination of the following 3 factors:

  • Knee musculature strength
  • Lower-limb symmetry (as measured with a single leg hop test)
  • Clinical examination of the knee (e.g., range of motion, edema)

They also reported that ACL failure or reinjury rates in these studies, with a minimum follow-up time of 2 years, ranged from 0 to 24%, and the injury rate of the contralateral ACL ranged from 0% to 15%.

Why is the reinjury rate reportedly as high as 24%?

The authors to suggest potential shortcomings of the current management of patients post-ACL reconstruction:

  1. Current post-ACL reconstruction rehabilitation programs may not be optimally effective in addressing deficits related to the initial injury and the subsequent surgical interventions;
  2. The criteria used to return an athlete to sports may not be adequate to identify residual functional deficits and fully assess readiness to return to play;
  3. Postsurgical rehabilitation, while addressing the deficits related to the injury and surgery, may not fully address the likely preinjury predisposing factors on the injured as well as the uninjured side;
  4. Residual deficits on the post surgical limb place the uninjured limb at greater risk of injuries upon return to high-level activities.

Over the past 10 years, extensive work has been done to identify risk factors for ACL injuries (Myer et al 2010, Renstrom et al 2008). There have been numerous studies performed that provide evidence on injury biomechanics and ACL injury risk (e.g. a non contact ACL injury is 2.5 times more likely to occur when the knee collapses inward during a jump landing task).

(See our injury prevention blog post for more information on the influence on movement and injury).

Knowing what we know now, is it possible to develop a “test” that can COMBINE the traditional medical testing WITH the functional and biomechanical aspect that we have been lacking?

Dr. Christopher Powers, PhD, PT, FACSM, FAPTA, from the Movement Performance Institute in Los Angeles, proposes a movement-based, biomechanical test that can be a step in the right direction in addressing the ACL reinjury conundrum.

Below is an example of the Return To Sport Testing that was performed at our IPIM clinic, based on the biomechanical evaluation developed by Dr. Powers.

With the advent of these biomechanical tests, we hope that more surgeons, athletes, coaches and parents will understand the importance of these tests and how it can be a powerful tool for athletes looking to return to play.

We at Institute for Precision In Movement can help. Visit us at our Redlands clinic for a complimentary (free) consulation to see how we can get you to the next level.

No one wants to reinjury their ACL…so why wait?

Be proactive, not reactive.

Peter Lingas


Based on the editiorial article authored by Dr. Guy Simoneau, PT, PhD, ATC and Dr. Kevin Wilk, PT, DPT in the Journal of Orthopedic and Sports Physical Therapy.