ACL Return to Sport Testing: It's Time to Step up Our Game

Area of Science:

• Orthopedic surgery
• Sports medicine
• Physical therapy

Background:

• Physical therapists play a crucial role in assessing athlete readiness for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR).
• Current RTS assessments often rely heavily on arbitrary timeframes rather than objective performance metrics.
• This overreliance on temporal factors may lead to suboptimal clinical decisions regarding athlete recovery and safety.

Purpose of the Study:

• To challenge the current status quo in RTS testing following ACLR.
• To propose a comprehensive model for RTS testing that integrates multiple critical factors.
• To improve the decision-making process for determining an athlete's safe return to sport.

Main Methods:

• This clinical commentary reviews current practices in RTS testing after ACLR.
• It critiques the limitations of time-based criteria for RTS decisions.
• A novel, robust model for RTS testing is presented, incorporating various data points.

Main Results:

• The current practice of using time as the primary determinant for RTS is identified as a significant limitation.
• A substantial gap exists between the ideal and actual practice of RTS testing in ACLR.
• The proposed model emphasizes a multi-faceted approach beyond simple temporal guidelines.

Conclusions:

• A paradigm shift is needed in how physical therapists assess RTS after ACLR.
• Integrating performance-based criteria, biological healing, stability, and psychological readiness is essential.
• The proposed model offers a more comprehensive and evidence-based framework for RTS decisions.