Return to Golf Rehabilitation Progression after Anterior Cruciate Ligament Reconstruction Using an Evidence-Based Foundation.
Sean Hazzard, Michael Young, Danielle Lonati and 1 others
PMID 42694050WHAT IT FOUND
A proposed six-phase return-to-golf framework after ACL reconstruction, built from biomechanics and rehab literature.
It is not validated. The authors call for a prospective pilot study before it can guide practice.
Key findings
01No study has directly tested the safety or effectiveness of this return-to-golf protocol in patients after ACL reconstruction; the authors frame it as a clinical commentary requiring prospective validation before it can be considered a standard of care.
02The proposed progression is criteria-based rather than time-based: quadriceps limb symmetry index thresholds of 70%, 80%, and 90% gate entry into partial wedges, full wedges/short irons, and long irons/driver respectively, and progression should not occur merely because a postoperative week has been reached.
03Laboratory studies show substantial loading in both the lead and trail knee during a golf swing, including greater net abduction moment impulse in the trail knee, so the same fundamental clinical requirements apply regardless of which knee was reconstructed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
No included study directly tested the safety or effectiveness of this protocol in patients after ACL reconstruction; it is a synthesis of laboratory biomechanics data and general ACLR rehab literature. Knee moments estimated during a golf swing are not equivalent to direct ACL graft strain, and the biomechanics studies were performed in healthy or post-arthroplasty golfers, not post-ACLR patients. Laboratory samples were small and heterogeneous, definitions of swing phases and forces varied across studies, and sex-specific evidence was limited. All phase windows, swing volumes, symptom rules, balance durations, and the on-course sequence are author-consensus recommendations, not validated cutoffs. The authors themselves state that a prospective pilot study is the next logical step and that the framework requires prospective validation before it can be considered a validated standard of care.
Declared interests
No funding source or conflict-of-interest declaration is present in the provided text.
The easy way to misread this
Do not treat the six-phase progression, the 70/80/90% limb-symmetry thresholds, or the swing-volume prescriptions as validated clinical standards. The authors state explicitly that no study has tested this protocol in post-ACLR patients, that all numeric thresholds are author-consensus starting points, and that prospective validation is required before it can be considered a standard of care. Following it as though it were evidence-based may give false confidence in a timeline that has never been tested in the population it is meant to serve.