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Int J Sports Med
DOI: 10.1055/a-2270-3233
Review

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations

Braidy S. Solie 
1   Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
2   Research, Twin Cities Orthopedics, Edina, MN, United States
,
Luke V. Tollefson
2   Research, Twin Cities Orthopedics, Edina, MN, United States
,
Christopher P. Doney
1   Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
,
Jeremy M. J. O'Keefe
1   Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
,
Will C. Thompson
3   Sports Science, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
,
Robert F. LaPrade
4   Orthopedics, Twin Cities Orthopedics, Edina, MN, United States
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Abstract

Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.

Keywords

ACLR - rehabilitation - performance testing - pre-injury level of sport - psychological readiness - return to sport


Publication History

Received: 30 August 2023

Accepted: 30 January 2024

Article published online:
25 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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