Post ACL repair: When to return to sport?

Post ACL repair: When to return to sport?

Returning to sport too soon after having an ACL repair gives a much higher chance or re-rupturing the graft, but when is the best time to return to sport? Recent research shows

  • 5 to 6 key performance indicators were used including quads strength, hop tests and timed mobility exercises.
  • Operated leg needs to be performing at 90% of non-operated
  • 38% of people who did not meet this went onto re rupture compared to 5% who did meet this criteria
  • Every month you delay returning to sport the rate of reinjury reduces 51%

Take home message?

1: make sure that before you return to sport that you have your knee assessed to make sure that you are not in the group that is at high risk of re-injury. Your physio will be able to assess your reediness to return to sport and make an exercise plan to address any deficits.

2: time is key! the earlier you return to sport less than 9months after the repair, the more likely you are to re-injure it.


A bit more on the studies for those geeks:

  • Grindem et al (2016) looked at 106 competitive athletes post ACL repair. 5 key performance indicators were performed where the patient needed to achieve 90% performance compared to their non-operated side. 38% of people who did not pass these criteria went on to re-injure their ACL as opposed to only 5% re-injury rates in those who passed. This study also showed that for every month that you delay returning to sport, the rate of re-injury reduces by 51%!
  • Krytsis et al (2016) looked at 158 athletes post ACL repair. 6 performance criteria were looked at in this study, once again with the expectation that they will achieve at least 90% performance compared to their in-injured side. Krytsis had similar results to Grindem with 38% of people who chose to return to sport before re-injuring their ACL as opposed to only 10% who passed. This study had an earlier return to sport period (8 months as opposed to 9) and may have had lower injury rates if they tested at 9months.

Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med50(13), 804-808.

Kyritsis, P., Bahr, R., Landreau, P., Miladi, R., & Witvrouw, E. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med, bjsports-2015.