Return to Sport after ACL Reconstruction

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

Many people in Durango know someone who has had an anterior cruciate ligament (ACL) injury of their knee if they have been lucky enough to have not had one them self. Much of the time, these injuries end up needing a surgical reconstruction depending on the severity of the sprain or tear to the ligament. One of the most common questions that we hear after an ACL reconstruction is when returning to sport activities is safe. The surgeon will often give strong recommendations to wait as long as possible, especially depending on the type of sport that the individual is getting back into. This is especially true in sports that require any twisting or pivoting of the knee, such as soccer, skiing, and football. In general, most people don’t love hearing this and I have often encountered patients who push back into their sport fairly quickly. 

A recent study published in one of my favorite peer-reviewed PT journals, the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), sought to find out what the implications are of returning to sport too soon.(1) The study specifically looked at young athletes (late teens to early and mid-20s) in regards to how quickly they returned to sport and how this impacted their rate of re-injury to the affected ACL.(1) Ultimately, this study found that “returning to knee-strenuous sport before ACL reconstruction was associated with an approximately 7-fold increased rate of sustaining a second ACL injury.”(1) “Knee-strenuous sports” included baseball, snowboarding, skiing, volleyball, basketball, football, soccer, and ice hockey” among others.

Something also very interesting that the researchers found was that the risk of re-injury was unaffected by whether or not the person achieved symmetrical muscle function or quadriceps muscle strength.(1) So, even if the person did everything they could to get strong and their strength of the surgical leg was equal to the non-surgical leg, they still had a significantly higher chance of reinjuring their ACL if they returned to sports before that 9 month mark.(1) The take away from all of this: if it is at all possible, you should WAIT to return to sport after an ACL reconstruction if you are a young athlete. Even though this study was not performed in older athletes, the argument may be made that this advice applies to them as well. If you have experienced an ACL injury and subsequent surgery and you want more information about when and how to safely return to sport, make sure you talk to your PT and surgeon about this timeframe. 

  1. Beischer S, Gustavsson L, et al. Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. J Orthop Sports Phys Ther 2020;50(2):83-90. doi:10.2519/jospt.2020.9071