ACL Risk of Reinjury: When Is It Safe to Return (Time or Criteria)

Anterior cruciate ligament reconstruction (ACLR) if done successfully improves stability, reduces laxity, and decreases the risk of future knee joint pathology and surgery [1, 2]. Significant advancements in surgical procedures and rehabilitation have led to improved functional outcomes and high expectations in return to sport (RTS) [3]. Despite the relatively high rate of successful outcomes following ACLR, graft failure during rehabilitation can occur [4]. In many cases, this limits an athlete’s ability to return to their pre-injury level of activity with reported rates that vary from 37% to 75% [2, 4, 5]. In a recent systematic review, Ardern et al. evaluated 69 studies and 7556 participants after ACLR. On average, 81% of patients returned to some kind of sport, 65% returned to their pre-injury level of sport, and only 55% returned to competitive level sport [6]. Even though recent studies show a great difference between expectations and RTS, RTS rates are generally reported as ranging from 60 to 80% [7–9].