Return to Sport After Anterior Cruciate Ligament Reconstruction: Time-Based Clearance and the Reinjury It Buys
DOI:
https://doi.org/10.5281/zenodo.22548298Keywords:
Anterior cruciate ligament reconstruction, Return to sport, Reinjury; Limb symmetry index, Hop test, Sports medicineAbstract
Clearance to return to sport after anterior cruciate ligament reconstruction (ACLR) has traditionally
been granted on a fixed timeline, most commonly around nine months after surgery, regardless of
demonstrated strength, hop-test symmetry, or psychological readiness. Athletes who fail simple discharge
criteria before returning to sport face roughly a six-fold higher risk of a second ACL injury than those
who pass, and limb symmetry index, the most widely used readiness metric, is measured inconsistently
across different tests -- hop-test symmetry can clear the conventional 90% threshold while isokinetic
quadriceps strength symmetry still falls well short of it in the same patient. Biological graft maturation
also appears to lag behind functional test performance, particularly in younger athletes, who carry a
disproportionately higher burden of second ACL injury. This review synthesises that evidence and sets
out what a criteria-based, rather than purely time-based, return-to-sport decision should weigh.
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