ACL Return to Sport Guidelines and Criteria

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Science

Background:

• Anterior cruciate ligament (ACL) injuries are common, with high reinjury rates and long-term consequences like osteoarthritis.
• Returning athletes to pre-injury performance levels after ACL reconstruction (ACL-R) presents significant clinical challenges.
• Current criteria for return-to-sport decisions after ACL-R are not fully established, impacting athlete safety and performance.

Purpose of the Study:

• To describe a functional testing algorithm (FTA) as a clinical decision-making tool for individualizing return to sports after ACL-R.
• To provide a framework for making informed decisions regarding athlete return to competition post-ACL-R.
• To review current evidence supporting the use of a FTA for safe and effective return to sport.

Main Methods:

• Review of current scientific evidence to support the development of a functional testing algorithm (FTA).
• Integration of quantitative and qualitative assessments for evaluating an athlete's readiness to return to sport.
• Consideration of biopsychosocial factors, impairment testing, strength, power, functional performance, and patient-reported outcomes.

Main Results:

• A multifactorial FTA provides a structured approach to the complex decision-making process for return to sport after ACL-R.
• The proposed FTA utilizes quantitative and qualitative criteria to aid clinicians in making informed decisions.
• While lacking predictive validity, the FTA offers practical guidelines for facilitating return-to-sport decisions, prioritizing athlete safety and performance.

Conclusions:

• Individualized return-to-sport protocols are essential following ACL reconstruction due to the multifaceted nature of recovery.
• A functional testing algorithm (FTA) can serve as a valuable tool for guiding clinical decisions, balancing safety and performance.
• Further research is needed to establish the predictive validity of FTAs in optimizing outcomes for athletes after ACL-R.