Time of administering return to sport testing following anterior cruciate ligament reconstruction: A systematic...

Recent evidence supports greater risk of reinjury with earlier return-to-sport. As early return-to-sport testing may promote clearance during times of elevated reinjury risk, the purpose of this study was to identify when return-to-sport testing is administered following ACL reconstruction.

A systematic review was conducted of studies where functional tests were administered post-ACL reconstruction to inform return-to-sport decisions. The meta-analysis was a pooled analysis using a random effects model. Time frequencies were obtained for approximate/serial timepoint studies.

A total of 1,086 articles were identified, and 143 studies were included. Ninety-one descriptive studies with 131 cohorts resulted in 9,135 individuals for analysis and 52 studies with approximate/serial-timepoints stratified into 60 cohorts resulted in 4,575 individuals for analysis. The mean time of return-to-sport test administration was 7.30 [7.07, 7.53] months post-ACL reconstruction. The most frequent time of return-to-sport testing from approximate/serial timepoint studies were 6 and 12-months. Return-to-sport test time differed between study continent, where North American studies (6.78 ± 0.97) administered return-to-sport tests earlier than Asia (7.70 ± 0.98), Europe (8.12 ± 1.89), and Australia (11.35 ± 1.63, p's < 0.01).

Return-to-sport testing is administered approximately 7-months following ACL reconstruction, though large variability exists. Conducting return-to-sport assessments at early timepoints may promote sport clearance before evidence-based recommendations.