• Dan Kao

When Can I Return to Sport after an ACL Injury?

So you’ve injured your ACL and need to undergo an ACL repair.

Many factors can play a role in the cause of an ACL injury, especially among female athletes. Part of the rehab process involves working on the modifiable factors to reduce the risk of re-injury, and maintaining stability. Interested in finding out more about these risk factors? Check out our Female ACL Injury Blog Series by Jenna Minecci!

But what now?! What should my rehab goals be?!

Although this is devastating for most people, what’s even more devastating is the need for repeat surgery due to complications. A lot of these complications do arise from premature return to activity. About 20% of athletes under the age of 25 re-injure themselves after surgery and even higher in younger athletes [1,2,3]. The literature and orthopedic surgery community has been grappling with this question of when is it safe to return. There is a subjective self- readiness scale (ACL-RSI) that is often used for athletes to return to sports based on when they “feel ready.”

It was recently published in the American Journal of Sports Medicine that this does not correlate with the physical readiness to return to sports and likely should be used with caution as the sole measure to determine if the athlete should return to sports [4]. There are some recent guidelines revealing that the criteria to return to activity is “simply” when the repaired knee exhibits the same strength, proprioception and function as the contralateral knee [5].

The criteria are as follows [5]:

  • Approximately equal strength of quadriceps, hamstring, hip musculature

  • Equal balance on single leg stance with eyes both open and closed

  • Ability to perform dynamic movements in all directions

  • Sport specific movements can be performed at full speed without producing pain or instability (can be a ramp up process)

These are a great set of criteria to follow and no athlete should return until they have achieved all 4. There is no time limit to meet these goals, but the literature suggests it should take about 8-12 months to achieve on average [5]. There are certainly athletes returning sooner than this, maybe around the 6-month mark, but it would be important that they meet the 4 criteria listed above before safely returning to activity. It is equally important to ensure that the athlete is psychologically ready to return to sports as well [6]. It’s important as a practitioner to advise the patient that they do risk re-injury and/or graft failure should they return to activity prematurely.

Ameeka George, MS, CPNP is a board certified Pediatric Nurse Practitioner specializing in Pediatric Orthopedic-Spine Surgery, with an emphasis on Cerebral Palsy, Scoliosis and autism.


Have more questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with a Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today! -----------


1) Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D. (2016). Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine44(7), 1861–1876. doi: 10.1177/0363546515621554

2) Dekker, T. J., Godin, J. A., Dale, K. M., Garrett, W. E., Taylor, D. C., & Riboh, J. C. (2017). Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury. The Journal of Bone and Joint Surgery99(11), 897–904. doi: 10.2106/jbjs.16.00758

3) Kay, J., Memon, M., Marx, R. G., Peterson, D., Simunovic, N., & Ayeni, O. R. (2018). Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 26(4), 1019–1036. doi: 10.1007/s00167-018-4830-9

4) O’Connor, R. F., King, E., Richter, C., Webster, K. E., & Falvey, É. C. (2019). No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine48(1), 78–84. doi: 10.1177/0363546519887952

5) Friedberg, R. P. (2020, March 4). Anterior cruciate ligament injury. Retrieved April 8, 2020, from https://www.uptodate.com/contents/anterior-cruciate-ligament-injury?csi=f7ef92f8-9ec9-4a76-8bd7-6c21f995a59a&source=contentShare

6) Czuppon, S., Racette, B. A., Klein, S. E., & Harris-Hayes, M. (2013). Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. British Journal of Sports Medicine48(5), 356–364. doi: 10.1136/bjsports-2012-091786

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