Skip to main content
SpringerLink
Log in

Time to Reflect on Return to Sport Timing Following ACL Reconstruction

  • Current Opinion
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

The time of return to sport following anterior cruciate ligament (ACL) reconstruction is a commonly discussed topic within clinical settings and the sports medicine literature. Emerging science has demonstrated protective effects of delaying the time of sport clearance on athlete reinjury. Though a single time cutoff is unlikely to be applicable for all athletes, large inconsistencies in the time of return to sport clearance are present in both the literature and within prescribed clinical protocols. A multitude of patient factors, such as perceived function, objective function, confidence, post-operative goals, among others, are vital for how athletes are progressed and released for sport participation. This Current Opinion article is constructed to discuss the time to return to sport after ACL reconstruction—factors that may influence timing decisions, how time is assessed within the scientific literature—and to promote discussion on this common topic within the sports medicine and athletic communities. The aim of the article is not to establish defined clinical time cutoffs for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Forrester LA, Schweppe EA, Popkin CA. Variability in rehabilitation protocols following pediatric anterior cruciate ligament (ACL) reconstruction. Phys Sportsmed. 2019;47(4):448–54.

    Article  PubMed  Google Scholar 

  2. Glattke KE, Tummala SV, Goldberg B, Menzer H, Chhabra A. There is substantial variation in rehabilitation protocols following anterior cruciate ligament reconstruction: a survey of 46 American Orthopaedic Surgeons. Arthroscopy J Arthrosc Relat Surg. 2023;39(3):578–89.

    Article  Google Scholar 

  3. Lin TJ. Editorial commentary: there is no standard for or standardization of postoperative rehabilitation protocols after anterior cruciate ligament reconstruction. Arthroscopy J Arthrosc Relat Surg. 2023;39(3):590–1.

    Article  Google Scholar 

  4. Lubowitz JH, Brand JC, Rossi MJ. Return-to-sport outcomes after anterior cruciate ligament surgical treatment may be improved by attention to modifiable factors and consideration of nonmodifiable factors. Arthrosc J Arthrosc Relat Surg. 2023;39(3):571–4.

    Article  Google Scholar 

  5. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–8.

    Article  PubMed  Google Scholar 

  6. Beischer S, Gustavsson L, Senorski EH, Karlsson J, Thomee C, Samuelsson K, Thomee R. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. J Orthop Sports Phys Ther. 2020;50(2):83.

    Article  PubMed  Google Scholar 

  7. Bodkin SG, Hertel J, Diduch DR, Saliba SA, Novicoff WM, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. Predicting ACL reinjury from return to activity assessments at 6-months post-surgery: a prospective cohort study. J Athl Train. 2021. https://doi.org/10.4085/1062-6050-0407.20.

    Article  PubMed Central  Google Scholar 

  8. King E, Richter C, Jackson M, Franklyn-Miller A, Falvey E, Myer GD, Strike S, Withers D, Moran R. Factors influencing return to play and second anterior cruciate ligament injury rates in level 1 athletes after primary anterior cruciate ligament reconstruction: 2-year follow-up on 1432 reconstructions at a single center. Am J Sports Med. 2020;48(4):812–24.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Webster KE, Feller JA, Klemm HJ. Second ACL injury rates in younger athletes who were advised to delay return to sport until 12 months after ACL reconstruction. Orthop J Sports Med. 2021;9(2):232596712098563.

    Article  Google Scholar 

  10. Nwachukwu BU, Voleti PB, Berkanish P, Chang B, Cohn MR, Williams RJ, Allen AA. Return to play and patient satisfaction after ACL reconstruction. J Bone Jt Surg-Am. 2017;99(9):720–5.

    Article  Google Scholar 

  11. Losciale JM, Zdeb RM, Ledbetter L, Reiman MP, Sell TC. The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2019;49(2):43.

    Article  PubMed  Google Scholar 

  12. Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial. Am J Sports Med. 2020;48(2):285–97.

    Article  PubMed  Google Scholar 

  13. Bilko TE, Paulos LE, Feagin JA, Lambert KL, Cunningham HR. Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries - analysis of 1984 questionnaire completed by ACL study-group. Am J Sports Med. 1986;14(2):143–7.

    Article  CAS  PubMed  Google Scholar 

  14. Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1990;18(3):292–9.

    Article  CAS  PubMed  Google Scholar 

  15. Adams D, Logerstedt D, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601–14.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Or Z, Cases C, Lisac M, Vrangbæk K, Winblad U, Bevan G. Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems. Health Econ Policy Law. 2010;5(3):269–93.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rogers MJ, Penvose I, Curry EJ, DeGiacomo A, Li XN. Medicaid health insurance status limits patient accessibility to rehabilitation services following ACL reconstruction surgery. Orthop J Sports Med. 2018;6(4):232596711876335.

    Article  Google Scholar 

  18. Passalent LA, Landry MD, Cott CA. Wait times for publicly funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in Ontario, Canada. Physiother Canada. 2009;61(1):5–14.

    Article  Google Scholar 

  19. Burroughs PJ, Kahan JB, Moore HG, Grauer JN, Gardner EC. Temporal utilization of physical therapy visits after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2021;9(2):232596712098229.

    Article  Google Scholar 

  20. Dempsey IJ, Norte GE, Hall M, Goetschius J, Slater LV, Cancienne JM, Werner BC, Diduch DR, Hart JM. Relationship between physical therapy characteristics, surgical procedure, and clinical outcomes in patients after ACL reconstruction. J Sport Rehabil. 2019;28(2):171–9.

    Article  PubMed  Google Scholar 

  21. Lisee C, Lepley AS, Birchmeier T, O’Hagan K, Kuenze C. Quadriceps strength and volitional activation after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Health. 2019;11(2):163–79.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Przybylak K, Sibinski M, Domzalski M, Kwapisz A, Momaya AM, Zielinska M. Supervised physiotherapy leads to a better return to physical activity after anterior cruciate ligament reconstruction. J Sports Med Phys Fitness. 2019;59(9):1551–7.

    Article  PubMed  Google Scholar 

  23. Walker A, Hing W, Lorimer A. The influence, barriers to and facilitators of anterior cruciate ligament rehabilitation adherence and participation: a scoping review. Sports Med-Open. 2020. https://doi.org/10.1186/s40798-020-00258-7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bodkin SG, Hertel J, Bruce AS, Diduch DR, Saliba SA, Novicoff WM, Hart JM. Patient function in serial assessments throughout the post-ACL reconstruction progression. Phys Ther Sport. 2021;47:85–90.

    Article  CAS  PubMed  Google Scholar 

  25. Yau WP, Chan YC. Evaluation of graft ligamentization by MRI after anterior cruciate ligament reconstruction. Am J Sports Med. 2023;51(6):1466–79.

    Article  CAS  PubMed  Google Scholar 

  26. Namdari S, Scott K, Milby A, Baldwin K, Lee GC. Athletic performance after ACL reconstruction in the women’s national basketball association. Phys Sportsmed. 2011;39(1):36–41.

    Article  PubMed  Google Scholar 

  27. Abed V, Dupati A, Hawk GS, Johnson D, Conley C, Stone AV. Return to play and performance after anterior cruciate ligament reconstruction in the national women’s soccer league. Orthop J Sports Med. 2023;11(5):232596712311649.

    Article  Google Scholar 

  28. Harris JD, Erickson BJ, Bach BR Jr, Abrams GD, Cvetanovich GL, Forsythe B, McCormick FM, Gupta AK, Cole BJ. Return-to-sport and performance after anterior cruciate ligament reconstruction in national basketball association players. Sports Health. 2013;5(6):562–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bodkin SG, Smith AC, Bergman BC, Huo D, Weber KA, Zarini S, Kahn D, Garfield A, Macias E, Harris-Love MO. Utilization of mid-thigh magnetic resonance imaging to predict lean body mass and knee extensor strength in obese adults. Front Rehabil Sci. 2022. https://doi.org/10.3389/fresc.2022.808538.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mody KS, Fletcher AN, Akoh CC, Parekh SG. Return to play and performance after anterior cruciate ligament reconstruction in national football league players. Orthop J Sports Med. 2022;10(3):232596712210796.

    Article  Google Scholar 

  31. Matava MJ, Howard DR, Polakof L, Brophy RH. Public perception regarding anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2014;96(10): e85.

    Article  PubMed  Google Scholar 

  32. Glogovac G, Schumaier AP, Grawe BM. Return to sport following revision anterior cruciate ligament reconstruction in athletes: a systematic review. Arthrosc J Arthrosc Related Surg. 2019;35(7):2222–30.

    Article  Google Scholar 

  33. Erickson BJ, Harris JD, Cvetanovich GL, Bach BR, Bush-Joseph CA, Abrams GD, Gupta AK, McCormick FM, Cole BJ. Performance and return to sport after anterior cruciate ligament reconstruction in male major league soccer players. Orthop J Sports Med. 2013;1(2):2325967113497189. https://doi.org/10.1177/2325967113497189.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Therapy and Athletic Training, University of Utah, 290 S 1850 E, HPER-W 113, Salt Lake City, UT, 84115, USA

    Stephan G. Bodkin

Authors
  1. Stephan G. Bodkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan G. Bodkin.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of Interest

The author has no conflicts or competing interests with the content of this article.

Author Contributions

SB conceived the idea for this article, wrote and revised the manuscript, and read and approved the final version.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bodkin, S.G. Time to Reflect on Return to Sport Timing Following ACL Reconstruction. Sports Med (2024). https://doi.org/10.1007/s40279-024-02017-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40279-024-02017-0

Search

Navigation