Is 9 months the sweet spot for male athletes to return to sport after anterior cruciate ligament reconstruction?

Review written by Dr Teddy Willsey info

Key Points

  1. Many clinicians are still using time as an important part of the return to sport decision after ACL surgery, however, the data on time remains inconclusive.
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BACKGROUND & OBJECTIVE

Over the past 40 years anterior cruciate ligament reconstruction (ACLR) rehabilitation has evolved from basic exercise protocols and pre-determined timelines to an individualized, progressive, and ultimately sport specific return to sport (RTS) process (1). The universally accepted minimum time frame for athletes to RTS used to be around six months, however recent studies over the past decade have indicated waiting nine months may significantly reduce injury risk (2,3).

Many of the criterion-based return to sport (RTS) approaches involve limb symmetry index (LSI) measurement on jump and strength tests. Despite the utility of using functional performance as a guide for rehabilitation, LSI has shown limited success in reducing second injury, highlighting the complex challenge of RTS decision making (4,5).

Many recent ACL RTS studies have failed to control for compliance and performance testing at the time of RTS, while others have shown minimal association between RTS time and second injury (6). The authors of this study aimed to explore the association between the time to RTS in male pivoting sports athletes two years post ACLR alongside other influential factors including rehabilitation adherence and complications.

Anterior cruciate ligament reconstruction rehabilitation has evolved from basic exercise protocols and pre-determined timelines to an individualized, progressive, and ultimately sport specific return to sport process.
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The impact of using discharge criteria is still unclear, a high limb symmetry index does not guarantee an athlete will avoid future injury, and waiting a certain amount of time is not a viable standalone method.

METHODS

  • This prospective observational study recruited male recreational (n = 310) and competitive (n = 220) athletes in football, basketball, handball, racket sports, and alpine skiing over a five-year collection period.
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