ACL Rehab: When Should I Return to Sport?

One of the biggest questions we tackle daily is 'when should I return to my sport after ACL surgery?' This article will help unpack our approach, the research, and the rationale behind our recommendations.

Data Doesn't Lie

• ✓25-31% of ACL patients re-tear their ACL
• ✓You have a 7x increased risk of re-tearing your ACL when returning before 9 months
• ✓For every month you return before the 9 month mark, your risk of re-tear increases by 10%
• ✓The re-injury rate decreases by 51% per month up until the 9 month mark where it plateaus

Why?

The surgery took a tendon and placed it where a ligament should be. The body goes through a process called religamentization that essentially converts the tendon into a functioning ligament — and this amazing process takes 9-12 months. It would make sense that we'd want this process close to complete before returning to sport.

It also takes thousands of reps to truly rewire new movement patterns. After ACL surgery, rewiring the brain is crucial and simply takes time, repetitions, and consistency.

Return to Sport Criteria

There is no scientific consensus on return to sport criteria post-ACLR, but here would be our preference for bare minimum criteria:

• ✓Hop test: >95-100% symmetry
• ✓SL vertical jump: >95-100% symmetry
• ✓Quad strength: >95-100% symmetry
• ✓ACL-RSI: >90%

Exceptions

Are there exceptions to the 9-month minimum? Ideally no. However, there are situations where an early return may be warranted (e.g. scholarship situations). We make sure to discuss the risks of returning too early and ensure the patient is on board — and our return to sport criteria never changes regardless of circumstance.

Our recommendation is always 9 months at a minimum, and the closer to 12 months the better. This is not to keep patients in rehab longer than needed, but to ensure we leave no stone unturned.