On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction.

This is a clinical commentary and single case report, not a controlled trial, so it cannot show that the progression works. The athlete received physical therapy, running, strengthening, lateral slide board work, agility, neuromuscular training, on-ice skating, and an ACL brace together, so the contribution of any one component cannot be separated. The proposed progression has not been rigorously tested, and its effect on future knee injury risk or long-term function is unknown. The case was complicated by meniscal involvement, a lateral collateral ligament sprain, delayed gym access, and limited ice time, so the timeline may not apply to simpler ACL reconstructions. The authors state they are unaware of empirical evidence supporting the use of knee effusion or joint soreness rules to guide progression. Follow-up is only to 22 months, and no control group is reported.

The authors declared no conflicts of interest.

Do not read this as evidence that the on-ice progression causes safe return to hockey. It describes one athlete who also received physical therapy, running, strengthening, lateral slide board work, agility, neuromuscular training, on-ice skating, and an ACL brace, and the authors say the progression is expert opinion that has not been rigorously tested.