ACL Return to Sport Testing: It's Time to Step up Our Game.
Casey Unverzagt, Evan Andreyo, Jeff Tompkins
PMID 34386294WHAT IT FOUND
Current ACL return-to-sport criteria rely too heavily on time and symmetry, which often overestimate readiness.
Proposed stricter testing includes higher symmetry targets, psychological readiness, and intrinsic risk factors like gender and family history. These recommendations are expert opinion and not yet validated.
Key findings
01Only 65% of individuals return to their preinjury level of sports participation following ACL reconstruction, with only 55% returning to competitive sports.
02Using a limb symmetry index for hop testing and strength assessment has the potential to overestimate knee function, as athletes can pass these tests while still having significant deficits compared to healthy norms.
03The proposed return-to-sport criteria have not yet been validated and may be less feasible for some clinicians due to equipment and time requirements.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The proposed RTS criteria and testing battery have not been validated. The recommendations are based on expert opinion and interpretation of existing literature, not new clinical trial data. Many of the proposed tests require specialized equipment (e.g., isokinetic dynamometers, force plates, reactive agility systems) that most outpatient clinics do not have. The paper does not provide evidence that the proposed stricter criteria actually improve RTS rates or reduce reinjury compared to current standard care.
Declared interests
The authors affirm that they have no financial affiliation or involvement with any commercial organization that has a direct financial interest in the manuscript.
The easy way to misread this
Do not implement the proposed testing battery as a standard of care. The authors explicitly state these criteria are not yet validated, and the recommendations are expert opinion rather than evidence-based guidelines. Adopting unvalidated, resource-intensive testing without clinical trial support may lead to unnecessary delays in return to sport or false reassurance if the tests are not administered correctly.