Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction

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.

Zusammenfassung

Die Rückkehr zum Sport („return to sport“, RTS) nach einer Rekonstruktion des vorderen Kreuzbands (VKB-R) kann für Sportler eine komplexe Herausforderung sein, da die Wiederaufnahme des vorherigen Leistungsniveaus oft hinter den Erwartungen des Sportlers zurückbleibt. Bei den Sportlern, die ihren Sport wiederaufnehmen, bleibt die Knieverletzungsrate hoch, und mehrere Studien zeigten bei der Rückkehr zum Sport nach VKB-R eine Beeinträchtigung der sportlichen Leistung sowie eine Reduktion der Spielzeit, Produktivität und Karrieredauer. Um die Rate erneuter Verletzungen zu verringern und die Ergebnisse bei der Rückkehr zum Sport zu verbessern, haben mehrere Konsens- und klinische Praxisleitlinien zur Rückkehr zum Sport nach VKB-R empfohlen, dass vor der medizinischen Freigabe einer uneingeschränkten Teilnahme am Sport objektive RTS-Testkriterien erfüllt werden müssen. Wenngleich durch das Erreichen der RTS-Testkriterien die Rückkehrraten zum Sport nach VKB-R verbessert werden können, scheinen die aktuellen Kriterien keine valide Vorhersage einer sicheren Rückkehr zum Sport zu ermöglichen. Daher besteht die Notwendigkeit, die verschiedenen Faktoren, die bei einer erfolgreichen Rückkehr zum ursprünglichen Leistungsniveau nach VKB-R eine Rolle spielen, zu überprüfen, den Nutzen objektiver Leistungstests und RTS-Kriterien zu klären, die Entscheidungsfindung zur sicheren Rückkehr zum Sport weiter zu erörtern und Strategien zur Verringerung des Risikos von (erneuten) VKB-Verletzungen bei der Rückkehr zum Sport vorzustellen. Dieser Artikel bietet eine praxisnahe Übersicht der aktuellen Literatur zur Rückkehr zum Sport nach VKB-R sowie medizinische Empfehlungen für die Rehabilitation und die Entscheidungsfindung zur Wiederaufnahme des Sports.

Keywords

ACLR - Rehabilitation - Performance Testing - Pre-injury Level of Sport - Psychological Readiness - Return to Sport

Schlüsselwörter

VKB-R - Rehabilitation - Leistungstest - vorheriges Leistungsniveau - psychologische Bereitschaft - Rückkehr zum Sport

Publication History

Received: 30 August 2023

Accepted after revision: 31 January 2024

Article published online:
21 May 2025

• References

• 1 Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med 2017; 36: 1-8
• 2 Lynch TS, Parker RD, Patel RM. et al. The impact of the Multicenter Orthopaedic Outcomes Network (MOON) research on anterior cruciate ligament reconstruction and orthopaedic practice. J Am Acad Orthop Surg 2015; 23: 154
• 3 Granan L-P, Bahr R, Steindal K. et al. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 2008; 36: 308-315
• 4 Murgier J, Hansom D, Clatworthy M. Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts. J ISAKOS 2020; 5: 32-35
• 5 Carmichael JR, Cross MJ. Why bone-patella tendon-bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction. Br J Sports Med 2009; 43: 323-325
• 6 Gifstad T, Foss OA, Engebretsen L. et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: A registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 2014; 42: 2319-2328
• 7 Group MK, Spindler KP, Huston LJ. et al. Anterior cruciate ligament reconstruction in high school and college-aged athletes: does autograft choice influence anterior cruciate ligament revision rates?. Am J Sports Med 2020; 48: 298-309
• 8 Laboute E, James-Belin E, Puig P. et al. Graft failure is more frequent after hamstring than patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 2018; 26: 3537-3546
• 9 Sullivan JP, Huston LJ, Zajichek A. et al. Incidence and predictors of subsequent surgery after anterior cruciate ligament reconstruction: A 6-year follow-up study. Am J Sports Med 2020; 48: 2418-2428
• 10 Rahardja R, Love H, Clatworthy MG. et al. Higher rate of return to preinjury activity levels after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone versus hamstring tendon autograft in high-activity patients: results from the New Zealand ACL registry. Am J Sports Med 2021; 49: 3488-3494
• 11 Ardern CL, Taylor NF, Feller JA. et al. Fifty-five percent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48
• 12 Meredith SJ, Rauer T, Chmielewski TL. et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS 2021; 6: 138-146
• 13 Webster KE, Feller JA. Expectations for return to preinjury sport before and after anterior cruciate ligament reconstruction. Am J Sports Med 2019; 47: 578-583
• 14 Forsythe B, Lavoie-Gagne OZ, Forlenza EM. et al. Return-to-play times and player performance after ACL reconstruction in elite UEFA professional soccer players: A matched-cohort analysis from 1999 to 2019. Orthop J Sports Med 2021; 9: 23259671211008892
• 15 Balendra G, Jones M, Borque KA. et al. Factors affecting return to play and graft re-rupture after primary ACL reconstruction in professional footballers. Knee Surg Sports Traumatol Arthrosc 2022; 30: 1-9
• 16 Erickson BJ, Harris JD, Cvetanovich GL. et al. Performance and return to sport after anterior cruciate ligament reconstruction in male Major League Soccer players. Orthop J Sports Med 2013; 1: 2325967113497189
• 17 Harris JD, Erickson BJ, Bach Jr BR. et al. Return-to-sport and performance after anterior cruciate ligament reconstruction in National Basketball Association players. Sports Health 2013; 5: 562-568
• 18 Cinque ME, Hannon CP, Bohl DD. et al. Return to sport and performance after anterior cruciate ligament reconstruction in National Football League linemen. Orthop J Sports Med 2017; 5: 2325967117711681
• 19 Abed V, Dupati A, Hawk GS. et al. Return to play and performance after anterior cruciate ligament reconstruction in the National Women’s Soccer League. Orthop J Sports Med 2023; 11: 23259671231164944
• 20 Maman D, Martonovich N, Alf L. et al. The impact of anterior cruciate ligament (ACL) tears on game statistics among National Basketball Association (NBA) players: A retrospective cohort study. General Surgery and Clinical Medicine 2023; 1: 52-56
• 21 Wright RW, Haas AK, Anderson J. et al. Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines. Sports Health 2015; 7: 239-243
• 22 Van Melick N, Van Cingel RE, Brooijmans F. et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016; 50: 1506-1515
• 23 Logerstedt DS, Snyder-Mackler L, Ritter RC. et al. Knee stability and movement coordination impairments: Knee ligament sprain. J Orthop Sports Phys Ther 2010; 40: A1-A37
• 24 Kotsifaki R, Korakakis V, King E. et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57: 500-514
• 25 Ithurburn MP, Altenburger AR, Thomas S. et al. Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later. Knee Surg Sports Traumatol Arthrosc 2018; 26
• 26 Cristiani R, Mikkelsen C, Edman G. et al. Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28: 369-380
• 27 Hetsroni I, Wiener Y, Ben-Sira D. et al. Symmetries in muscle torque and landing kinematics are associated with maintenance of sports participation at 5 to 10 years after ACL reconstruction in young men. Orthop J Sports Med 2020; 8: 2325967120923267
• 28 Webster KE, Hewett TE. What is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis. Sports Med 2019; 49: 917-929
• 29 Paterno MV, Rauh MJ, Thomas S. et al. Return-to-sport criteria after anterior cruciate ligament reconstruction fail to identify the risk of second anterior cruciate ligament injury. J Athl Train 2022; 57: 937-945
• 30 Welling W, Benjaminse A, Lemmink K. et al. Passing return to sports tests after ACL reconstruction is associated with greater likelihood for return to sport but fail to identify second injury risk. Knee 2020; 27: 949-957
• 31 Toole AR, Ithurburn MP, Rauh MJ. et al. Young athletes cleared for sports participation after anterior cruciate ligament reconstruction: How many actually meet recommended return-to-sport criterion cutoffs?. J Orthop Sports Phys Ther 2017; 47: 825-833
• 32 Markström JL, Naili JE, Häger CK. A minority of athletes pass symmetry criteria in a series of hop and strength tests irrespective of having an ACL reconstructed knee or being noninjured. Sports Health 2023; 15: 45-51
• 33 Gould RJ, Ridout AJ, Newton JL. Relative energy deficiency in sport (RED-S) in adolescents-a practical review. Int J Sports Med 2022; 44: 236-246
• 34 Munn Z, Peters MD, Stern C. et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018; 18: 1-7
• 35 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg 2021; 88: 105906
• 36 Erickson BJ, Harris JD, Cole BJ. et al. Performance and return to sport after anterior cruciate ligament reconstruction in National Hockey League players. Orthop J Sports Med 2014; 2: 2325967114548831
• 37 Erickson BJ, Chalmers PN, D’Angelo J. et al. Performance and return to sport after anterior cruciate ligament reconstruction in professional baseball players. Orthop J Sports Med 2019; 7: 2325967119878431
• 38 Erickson BJ, Harris JD, Heninger JR. et al. Performance and return-tosport after ACL reconstruction in NFL quarterbacks. Orthopedics 2014; 37: e728-e734
• 39 Manoharan A, Barton D, Khwaja A. et al. Return to play rates in NFL wide receivers and running backs after ACL reconstruction: An updated analysis. Orthop J Sports Med 2021; 9: 2325967120974743
• 40 Mody KS, Fletcher AN, Akoh CC. et al. Return to play and performance after anterior cruciate ligament reconstruction in National Football League players. Orthop J Sports Med 2022; 10: 23259671221079637
• 41 Tramer JS, Khalil LS, Ziedas A. et al. Return to play and performance in the Women’s National Basketball Association after anterior cruciate ligament reconstruction. Orthop J Sports Med 2020; 8: 2325967120947078
• 42 DeFazio MW, Curry EJ, Gustin MJ. et al. Return to sport after ACL reconstruction with a BTB versus hamstring tendon autograft: A systematic review and meta-analysis. Orthop J Sports Med 2020; 8: 2325967120964919
• 43 Hopper GP, Pioger C, Philippe C. et al. Risk factors for anterior cruciate ligament graft failure in professional athletes: An analysis of 342 patients with a mean follow-up of 100 months from the SANTI study group. Am J Sports Med 2022; 50: 3218-3227
• 44 Salem HS, Huston LJ, Zajichek A. et al. Anterior cruciate ligament reconstruction with concomitant meniscal repair: is graft choice predictive of meniscal repair success?. Orthop J Sports Med 2021; 9: 23259671211033584
• 45 Longstaffe R, Leiter J, Gurney-Dunlop T. et al. Return to play and career length after anterior cruciate ligament reconstruction among Canadian professional football players. Am J Sports Med 2020; 48: 1682-1688
• 46 Gupta R, Kapoor A, Soni A. et al. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft is associated with higher and earlier return to sports as compared to hamstring tendon graft. Knee Surg Sports Traumatol Arthrosc 2020; 28: 3659-3665
• 47 Dai W, Leng X, Wang J. et al. Quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Am J Sports Med 2021; 50: 3635465211030259
• 48 Solie B, Monson J, Larson C. Graft-specific surgical and rehabilitation considerations for anterior cruciate ligament reconstruction with the quadriceps tendon autograft. Int J Sports Phys Ther 2023; 18: 493
• 49 Herman ZJ, Benvegnu N, Dadoo S. et al. Outcomes of bone-patellar tendon-bone autograft and quadriceps tendon autograft for ACL reconstruction in an all-female soccer player cohort with mean 4.8-year follow up. Journal of ISAKOS. 2023
• 50 Runer A, Suter A, di Sarsina TR. et al. Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 years. J ISAKOS 2023; 8: 60-67
• 51 Rakauskas R, Šiupšinskas L, Streckis V. et al. Hamstring vs. all-softtissue quadriceps tendon autograft for anterior cruciate ligament reconstruction in adolescent athletes: Early follow-up results of a prospective study. Appl Sci 2023; 13: 2076-3417
• 52 Getgood AM, Bryant DM, Litchfield R. 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: 285-297
• 53 Pioger C, Gousopoulos L, Hopper GP. et al. Clinical outcomes after combined ACL and anterolateral ligament reconstruction versus isolated ACL reconstruction with bone-patellar tendon-bone grafts: A matched-pair analysis of 2018 patients from the SANTI Study Group. Am J Sports Med 2022; 50: 3493-3501
• 54 Svantesson E, Piussi R, Beischer S. et al. Only 10% of patients with a concomitant MCL injury return to their preinjury level of sport 1 year after ACL reconstruction: A matched comparison with isolated ACL reconstruction. Sports Health 2024; 16: 124-135
• 55 Bakshi NK, Khan M, Lee S. et al. Return to play after multiligament knee injuries in National Football League athletes. Sports Health 2018; 10: 495-499
• 56 Etzel CM, Nadeem M, Gao B. et al. Graft choice for anterior cruciate ligament reconstruction in women aged 25 years and younger: A systematic review. Sports Health 2022; 14: 829-841
• 57 Sundemo D, Hamrin Senorski E, Karlsson L. et al. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: A systematic review. BMJ Open Sport Exerc Med 2019; 5: e000620
• 58 Firth AD, Bryant DM, Litchfield R. et al. Predictors of graft failure in young active patients undergoing hamstring autograft anterior cruciate ligament reconstruction with or without a lateral extraarticular tenodesis: TShe stability experience. Am J Sports Med 2022; 50: 384-395
• 59 Grindem H, Granan L-P, Risberg MA. et al. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 2015; 49: 385-389
• 60 Failla MJ, Logerstedt DS, Grindem H. et al. Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med 2016; 44: 2608-2614
• 61 Brinlee AW, Dickenson SB, Hunter-Giordano A. et al. ACL reconstruction rehabilitation: Clinical data, biologic healing, and criterion-based milestones to inform a return-to-sport guideline. Sports Health 2022; 14: 770-779
• 62 Keays SL, Bullock-Saxton J, Newcombe P. et al. The effectiveness of a pre-operative home-based physiotherapy programme for chronic anterior cruciate ligament deficiency. Physiother Res Int 2006; 11: 204-218
• 63 Carter HM, Littlewood C, Webster KE. et al. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: A systematic review. BMC Musculoskelet Disord 2020; 21: 1-13
• 64 Giesche F, Niederer D, Banzer W. et al. Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review. PLoS One 2020; 15: e0240192
• 65 Shaarani SR, O’Hare C, Quinn A. et al. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med 2013; 41: 2117-2127
• 66 Han F, Banerjee A, Shen L. et al. Increased compliance with supervised rehabilitation improves functional outcome and return to sport after anterior cruciate ligament reconstruction in recreational athletes. Orthop J Sports Med 2015; 3: 2325967115620770
• 67 Della Villa F, Andriolo L, Ricci M. et al. Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28: 463-469
• 68 Edwards PK, Ebert JR, Joss B. et al. Patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction: The importance of patient age and postoperative rehabilitation. Orthop J Sports Med 2018; 6: 232596711879757
• 69 Johnson JL, Capin JJ, Arundale AJH. et al. A secondary injury prevention program may decrease contralateral anterior cruciate ligament injuries in female athletes: 2-year injury rates in the ACL-SPORTS randomized controlled trial. J Orthop Sports Phys Ther 2020; 50: 523-530
• 70 Nyland J, Greene J, Carter S. et al. Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28: 3676-3685
• 71 Solie B, Kiely M, Doney C. et al. Return to elite-level basketball after surgical reconstruction of the anterior cruciate ligament and medial collateral ligament of the knee with meniscal repairs-it takes teamwork and time to restore performance: A case report. JOSPT Cases 2022; 2: 1-22
• 72 Arundale AJH, Capin JJ, Zarzycki R. et al. Two year ACL reinjury rate of 2.5%: outcomes report of the men in a secondary ACL injury revention program (ACL-SPORTS). Int J Sports Phys Ther 2018; 13: 422-431
• 73 Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med 2019; 49: 1043-1058
• 74 Burgi CR, Peters S, Ardern CL. et al. Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med 2019; 53: 1154-1161
• 75 Pietrosimone B, Davis-Wilson HC, Seeley MK. et al. Gait biomechanics in individuals meeting sufficient quadriceps strength cutoffs after anterior cruciate ligament reconstruction. J Athl Train 2021; 56: 960-966
• 76 Maestroni L, Papadopoulos K, Turner A. et al. Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 48: 209-218
• 77 Kotsifaki A, Van Rossom S, Whiteley R. et al. Symmetry in triple hop distance hides asymmetries in knee function after ACL reconstruction in athletes at return to sports. Am J Sports Med 2022; 50: 441-450
• 78 Kotsifaki A, Whiteley R, Van Rossom S. et al. Single leg hop for distance symmetry masks lower limb biomechanics: Time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?. Br J Sports Med 2022; 56: 249-256
• 79 Chen P, Wang L, Dong S. et al. Can symmetry of single-leg vertical jump height represent normal lower limb biomechanics of athletes after anterior cruciate ligament reconstruction?. Sports Health 2023;
• 80 Ithurburn MP, Longfellow MA, Thomas S. et al. Knee function, strength, and resumption of preinjury sports participation in young athletes following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2019; 49: 145-153
• 81 Webster KE, McPherson AL, Hewett TE. et al. Factors associated with a return to preinjury level of sport performance after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2019; 47: 2557-2562
• 82 Kitaguchi T, Tanaka Y, Takeshita S. et al. Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28: 2203-2212
• 83 Kim S-H, Lee J-W, Kim S-G. et al. Low rate of return to preinjury Tegner activity level among recreational athletes: Results at 1 year after primary ACL reconstruction. Orthop J Sports Med 2021; 9: 2325967120975751
• 84 Nawasreh Z, Logerstedt D, Cummer K. et al. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med 2018; 52: 375-375
• 85 Davies WT, Myer GD, Read PJ. Is it time we better understood the tests we are using for return to sport decision making following ACL reconstruction? A critical review of the hop tests. Sports Med 2020; 50: 485-495
• 86 Kotsifaki A, Van Rossom S, Whiteley R. et al. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Br J Sports Med 2022; 56: 490-498
• 87 Grindem H, Snyder-Mackler L, Moksnes H. et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808
• 88 Paterno MV, Huang B, Thomas S. et al. Clinical factors that predict a second ACL injury after ACL reconstruction and return to sport: Preliminary development of a clinical decision algorithm. Orthop J Sports Med 2017; 5: 2325967117745279
• 89 King E, Richter C, Daniels KAJ. et al. Biomechanical but not strength or performance measures differentiate male athletes who experience ACL reinjury on return to level 1 sports. Am J Sports Med 2021; 49: 918-927
• 90 Blucher NC, Feller JA, Devitt BM. et al. Is there an association in young patients between quadriceps or hamstring strength after ACL reconstruction and graft rupture. Orthop J Sports Med 2022; 10: 232596712211010
• 91 Bodkin SG, Hertel J, Diduch DR. et al. Predicting anterior cruciate ligament reinjury from return-to-activity assessments at 6 months postsurgery: A prospective cohort study. J Athl Train 2022; 57: 325-333
• 92 Kew ME, Bodkin S, Diduch DR. et al. Reinjury rates in adolescent patients 2 years following ACL reconstruction. J Pediatr Orthop 2022; 42: 90-95
• 93 Marigi EM, Hale RF, Bernard CD. et al. Are 6-month functional and isokinetic testing measures risk factors for second anterior cruciate ligament injuries at long-term follow-up?. J Knee Surg 2022; 36: 1060-1068
• 94 Simonson R, Piussi R, Högberg J. et al. Effect of quadriceps and hamstring strength relative to body weight on risk of a second ACL injury: A cohort study of 835 patients who returned to sport after ACL reconstruction. Orthop J Sports Med 2023; 11: 23259671231157386
• 95 Straub RK, Powers CM. Is muscular strength a predictor for initial or secondary ACL injury? A scoping review of prospective studies. Phys Ther Sport 2023; 61: 91-101
• 96 Paterno MV, Thomas S, VanEtten KT. et al. Confidence, ability to meet return to sport criteria, and second ACL injury risk associations after ACL-reconstruction. J Orthop Res 2022; 40: 182-190
• 97 Piussi R, Beischer S, Thomeé R. et al. Greater psychological readiness to return to sport, as well as greater present and future knee-related self-efficacy, can increase the risk for an anterior cruciate ligament re-rupture: A matched cohort study. Arthroscopy 2022; 38: 1267-1276.e1261
• 98 Zarzycki R, Cummer K, Arhos E. et al. Female athletes with better psychological readiness are at higher risk for second ACL injury after primary ACL reconstruction. Sports Health 2024; 16: 149-154
• 99 Bodkin SG, Hertel J, Bruce AS. et al. Patient function in serial assessments throughout the post-ACL reconstruction progression. Phys Ther Sport 2021; 47: 85-90
• 100 Paterno MV, Schmitt LC, Ford KR. et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 2010; 38: 1968-1978
• 101 Hewett TE, Webster KE, Hurd WJ. Systematic selection of key logistic regression variables for risk prediction analyses: A five factor maximum model. Clin J Sport Med 2019; 29: 78
• 102 Forelli F, Traulle M, Bechaud N. et al. Predict anterior cruciate ligament injury in elite male soccer players? Focus on the five factors maximum model. Int J Physiother 2021; 8: 211-216
• 103 Ithurburn MP, Paterno MV, Thomas S. et al. Clinical measures associated with knee function over two years in young athletes after ACL reconstruction. Knee 2019; 26: 355-363
• 104 Gouttebarge V, Aoki H, Ekstrand J. et al. Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?. Knee Surg Sports Traumatol Arthrosc 2016; 24: 3934-3942
• 105 Kiliç Ö, Aoki H, Goedhart E. et al. Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: A longitudinal analysis of 12-month follow-up data. Knee Surg Sports Traumatol Arthrosc 2018; 26: 946-954
• 106 Reardon CL, Hainline B, Aron CM. et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53: 667-699
• 107 Nwachukwu BU, Adjei J, Rauck RC. et al. How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? A systematic review. Orthop J Sports Med 2019; 7: 2325967119845313
• 108 Ardern CL, Taylor NF, Feller JA. et al. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41: 1549-1558
• 109 Sadeqi M, Klouche S, Bohu Y. et al. Progression of the psychological ACL-RSI score and return to sport after anterior cruciate ligament reconstruction: A prospective 2-year follow-up study from the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST). Orthop J Sports Med 2018; 6: 2325967118812819
• 110 Xiao M, van Niekerk M, Trivedi NN. et al. Patients who return to sport after primary anterior cruciate ligament reconstruction have significantly higher psychological readiness: A systematic review and meta-analysis of 3744 patients. Am J Sports Med 2023; 51: 2774-2783
• 111 Sheean AJ, Lubowitz JH, Brand JC. et al. Psychological readiness to return to sport: fear of reinjury is the leading reason for failure to return to competitive sport and is modifiable. Arthroscopy 2023; 39: 1775-1778
• 112 McPherson AL, Feller JA, Hewett TE. et al. Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. Am J Sports Med 2019; 47: 857-862
• 113 Piussi R, Simonson R, Högberg J. et al. Psychological patient-reported outcomes cannot predict a second anterior cruciate ligament injury in patients who return to sports after an anterior cruciate ligament reconstruction. Int J Sports Phys Ther 2022; 17: 1340-1350
• 114 Fältström A, Kvist J, Hägglund M. Are we jumping to the wrong conclusions? Longer jumps and more hops in female football players who went on to sustain a primary or secondary ACL injury compared to those who did not. Sports Med Open 2023; 9: 105
• 115 Fältström A, Kvist J, Hägglund M. High risk of new knee injuries in female soccer players after primary anterior cruciate ligament reconstruction at 5-to 10-year follow-up. Am J Sports Med 2021; 49: 3479-3487
• 116 Webster KE. Editorial commentary: Why the mind matters in anterior cruciate ligament injury recovery: Psychological readiness and return to sport. Arthroscopy 2022; 38: 1277-1278
• 117 Eliya Y, Nawar K, Rothrauff BB. et al. Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture and higher rates of rotatory knee stability: A metaanalysis. J ISAKOS 2020; 5: 359-370
• 118 Diermeier T, Rothrauff BB, Engebretsen L. et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Orthop J Sports Med 2020; 8: 232596712093109
• 119 Rossi MJ, Brand JC. Rehabilitation is the critical ingredient to optimize return to sport in athletes. Arthroscopy 2022; 38: 7-9
• 120 Dauty M, Menu P, Mesland O. et al. Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery. Eur J Sport Sci 2022; 22: 627-635
• 121 Young BL, Hammond KE. Editorial commentary: limited preoperative range of motion is associated with range of motion deficits after anterior cruciate ligament reconstruction: “if the knee is not straight, wait”. Arthroscopy 2023; 39: 1690-1691
• 122 Kim DK, Park G, Wang JH. et al. Preoperative quadriceps muscle strength deficit severity predicts knee function one year after anterior cruciate ligament reconstruction. Sci Rep 2022; 12: 5830
• 123 Cunha J, Solomon DJ. ACL prehabilitation improves postoperative strength and motion and return to sport in athletes. Arthrosc Sports Med Rehabil 2022; 4: e65-e69
• 124 Agarwal AR, Harris AB, Tarawneh O. et al. Delay of timing of anterior cruciate ligament reconstruction is associated with lower risk of arthrofibrosis requiring intervention. Arthroscopy 2023; 39: 1682-1689.e2
• 125 Heijne A, Werner S. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: A prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc 2007; 15: 472-473
• 126 Dejour D, Pungitore M, Valluy J. et al. Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27: 3481-3489
• 127 Marmura H, Getgood AMJ, Spindler KP. et al. Validation of a risk calculator to personalize graft choice and reduce rupture rates for anterior cruciate ligament reconstruction. Am J Sports Med 2021; 49: 1777-1785
• 128 Zhao D, Pan J-k, Lin F-z. et al. Risk factors for revision or rerupture after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. The American Journal of Sports Medicine 2023; 51: 3053-3075
• 129 Andrade R, Pereira R, van Cingel R. et al. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). British Journal of Sports Medicine 2020; 54: 512-519
• 130 Cavanaugh JT, Powers M. ACL rehabilitation progression: Where are we now. Curr Rev Musculoskelet Med 2017; 10: 289-296
• 131 Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 2009; 37: 471-480
• 132 Driban JB, Vincent HK, Trojian TH. et al. Preventing osteoarthritis after an anterior cruciate ligament injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58: 193-197
• 133 Smith AH, Capin JJ, Zarzycki R. et al. Athletes with bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction were slower to meet rehabilitation milestones and return-to-sport criteria than athletes with hamstring tendon autograft or soft tissue allograft: Secondary analysis from the ACL-SPORTS trial. J Orthop Sports Phys Ther 2020; 50: 259-266
• 134 Schwery NA, Kiely MT, Larson CM. et al. Quadriceps strength following anterior cruciate ligament reconstruction: normative values based on sex, graft type and meniscal status at 3, 6 & 9 months. Int J Sports Phys Ther 2022; 17: 434-444
• 135 Kay J, Liotta ES, Sugimoto D. et al. Assessment of return to sport after ACL reconstruction with soft tissue autograft in adolescent athletes: quadriceps versus hamstring tendon. Orthop J Sports Med 2023; 11: 2325-9671
• 136 Mouarbes D, Menetrey J, Marot V. et al. Anterior cruciate ligament reconstruction: A systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med 2019; 47: 3531-3540
• 137 Taberner M, Allen T, Cohen DD. Progressing rehabilitation after injury: Consider the ‘control-chaos continuum’. Br J Sports Med 2019; 53: 1132-1136
• 138 Yung KK, Ardern CL, Serpiello FR. et al. A framework for clinicians to improve the decision-making process in return to sport. Sports Med Open 2022; 8: 52
• 139 Lopes TJA, Simic M, Myer GD. et al. The effects of injury prevention programs on the biomechanics of landing tasks: A systematic review with meta-analysis. Am J Sports Med 2018; 46: 1492-1499
• 140 Thompson-Kolesar JA, Gatewood CT, Tran AA. et al. Age influences biomechanical changes after participation in an anterior cruciate ligament injury prevention program. Am J Sports Med 2018; 46: 598-606
• 141 Dix C, Arundale A, Silvers-Granelli H. et al. Biomechanical changes during a 90º cut in collegiate female soccer players with participation in the 11. Int J Sports Phys Ther 2021; 16: 671-680
• 142 Huang Y-L, Jung J, Mulligan CMS. et al. A majority of anterior cruciate ligament injuries can be prevented by injury prevention programs: A systematic review of randomized controlled trials and cluster-randomized controlled trials with meta-analysis. Am J Sports Med 2020; 48: 1505-1515
• 143 Furman T, Silvers-Granelli H. Return to Play After an Anterior Cruciate Ligament Injury: Prioritizing Neurological and Psychological Factors of the Decision-Making Algorithm. American Journal of Orthopedics (Belle Mead, N.J.) 2018 (47)
• 144 Kaplan Y, Witvrouw E. When is it safe to return to sport after ACL reconstruction? Reviewing the criteria. Sports Health 2019; 11: 301-305
• 145 Tandogan RN, Taşer Ö, Kayaalp A. et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 2004; 12: 262-270
• 146 Borchers JR, Kaeding CC, Pedroza AD. et al. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: A comparison of the MOON and MARS study groups. Am J Sports Med 2011; 39: 1889-1893
• 147 Kvist J, Kartus J, Karlsson J. et al. Results from the Swedish National Anterior Cruciate Ligament Register. Arthroscopy 2014; 30: 803-810
• 148 Shrier I. Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med 2015; 49: 1311-1315
• 149 Shrier I. Return to sport decision-based models. In: Noyes F, Barber-Westin S. , ed. Return To Sport After ACL Reconstruction and Other Knee Operations. Cham: Springer; 2019: 53-65
• 150 Chona D, Eriksson K, Young SW. et al. Return to sport following anterior cruciate ligament reconstruction: The argument for a multimodal approach to optimise decision-making: current concepts. J ISAKOS 2021; 6: 344-348
• 151 Bodkin SG, Rutherford MH, Diduch DR. et al. How much time is needed between serial “return to play” assessments to achieve clinically important strength gains in patients recovering from anterior cruciate ligament reconstruction?. Am J Sports Med 2020; 48: 70-77
• 152 Turk R, Shah S, Chilton M. et al. Critical criteria recommendations: Return to sport after ACL reconstruction requires evaluation of time after surgery of 8 months, > 2 functional tests, psychological readiness, and quadriceps/hamstring strength. Arthroscopy 2022; 39: 790-801.e6
• 153 Beischer S, Gustavsson L, Senorski EH. et al. 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: 83-90
• 154 Ramana P, Rebecca S, Bálint Z. et al. Better safe than sorry? A systematic review and meta-analysis on time to return to sport after ACL reconstruction as a risk factor for second ACL injury. Journal of Orthopaedic & Sports Physical Therapy 54: 1-30
• 155 Read PJ, Michael Auliffe S, Wilson MG. et al. Lower limb kinetic asymmetries in professional soccer players with and without anterior cruciate ligament reconstruction: nine months is not enough time to restore “functional” symmetry or return to performance. Am J Sports Med 2020; 48: 1365-1373
• 156 Martin RK, Wastvedt S, Pareek A. et al. Machine learning algorithm to predict anterior cruciate ligament revision demonstrates external validity. Knee Surg Sports Traumatol Arthrosc 2022; 30: 368-375
• 157 Jurgensmeier K, Till SE, Lu Y. et al. Risk factors for secondary meniscus tears can be accurately predicted through machine learning, creating a resource for patient education and intervention. Knee Surg Sports Traumatol Arthrosc 2023; 31: 518-529
• 158 Martin RK, Wastvedt S, Pareek A. et al. Ceiling effect of the combined Norwegian And Danish Knee Ligament Registers limits anterior cruciate ligament reconstruction outcome prediction. Am J Sports Med 2023; 51: 2324-2332
• 159 Bahr R. Why screening tests to predict injury do not work—and probably never will…: A critical review. Br J Sports Med 2016; 50: 776-780
• 160 Pappas E, Nightingale EJ, Simic M. et al. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. Br J Sports Med 2015; 49: 673-680
• 161 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. Arthroscopy 2023; 39: 571-574