Variability in Terminal Phase Timing and Return-to-Sport Criteria in ACL Reconstruction Rehabilitation Protocols: A Scoping Review of U.S. Academic Institutions.

Only protocols posted publicly on the internet were included. Hospitals and surgeons who keep their protocols internal are invisible here, so this is not a complete picture of US practice. Only public academic institutions listed by the AAMC were searched. Protocols used in private practice may look different. The review counts documents, not people. No patients were followed and no outcomes were collected, so it cannot say whether protocols with return-to-sport criteria produce better recoveries than protocols without them. The review itself notes that limb symmetry index can be misleading because weakness in the uninjured leg inflates the score, which matters when almost all the thresholds found were expressed this way. The counts of protocols with a stated end point to the final phase do not agree within the paper: the text reports 65 in one place and 67 in another, while a table reports 40 open-ended protocols against 52 in the text.

The authors state that they have no conflicts of interest to disclose. No funding source is reported in the text supplied.

Do not read this as evidence that one rehabilitation protocol is better than another, or that protocols without return-to-sport criteria produce worse results. The review examined documents, not patients. No patients were followed and no outcomes were measured, so it cannot tell you whether any of this variability affects how people recover or whether they get injured again.