Return to Sports

A common misconception is that it’s safe to return to sports six months after ACL reconstruction. However, a wealth of research suggests that this timeline may be too optimistic for many patients. The literature demonstrates that patients who return to sport within six months post-surgery experience significantly higher reinjury rates.

Recent studies have demonstrated that athletes who return to sport before 9 months after surgery have as high as a 7x greater risk of reinjury than those who delay until after 9 months. Similarly, for every month after 8 months that return to sport was delayed reduced injury risk by 28%. ^(1-4)

It’s important to approach with skepticism any claims promising a safe return to sport at the six-month mark, as every individual’s recovery timeline is unique and depends on numerous physical and psychological factors.

1. Kaplan Y, Witvrouw E. When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria. Sports Health. 2019 Jul/Aug;11(4):301-305. doi: 10.1177/1941738119846502. Epub 2019 May 28. PMID: 31136725; PMCID: PMC6600576.
2. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016 Jul;50(13):804-8. doi: 10.1136/bjsports-2016-096031. Epub 2016 May 9. PMID: 27162233; PMCID: PMC4912389.
3. Beischer S, Gustavsson L, Senorski EH, Karlsson J, Thomeé C, Samuelsson K, Thomeé R. Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. J Orthop Sports Phys Ther. 2020 Feb;50(2):83-90. doi: 10.2519/jospt.2020.9071. Erratum in: J Orthop Sports Phys Ther. 2020 Jul;50(7):411. PMID: 32005095.
4. Bodkin SG, Hertel J, Diduch DR, Saliba SA, Novicoff WM, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prospective Cohort Study. J Athl Train. 2022 Apr 1;57(4):325-333. doi: 10.4085/1062-6050-0407.20. PMID: 35439312; PMCID: PMC9020598.

Physical Factors

Several physical factors influence when it is safe to return to sport after ACL reconstruction. These include:

• Strength and Stability: Your operated knee needs to regain close to equal strength and stability as your non-operated knee. This requires consistent and progressive rehabilitation. You will undergo testing with your physical therapist to assess your strength levels as you get closer to going back to sports.
• Functional Ability: You should be able to perform sport-specific drills and movements comfortably and with confidence.
• Conditioning and Endurance: It is important to be in good cardiovascular shape before returning to sports. Although your strength and mechanics may be good when you first return to sports, as you get tired throughout the game your form may worsen, placing you at an increased risk for re-injury.
• Physiological Healing: The graft used in your ACL reconstruction needs time to heal and mature. This process actually takes up to two years to fully occur. However, most experts agree that at least nine to twelve months is sufficient for a safe return to cutting and contact sports.

Psychological Factors

Psychological readiness is just as crucial for a safe return to sport. Factors include:

• Confidence: You need to feel confident in your knee’s ability to handle the demands of your sport.
• Fear of Reinjury: Overcoming the fear of reinjury is a significant part of the recovery process. Returning to sport with this fear can alter your biomechanics, potentially increasing the risk of reinjury.
• Mental Preparedness: You need to be mentally ready to return to the same level of activity as before your injury.

Your knee surgeon Dr. Ben Mayo uses a comprehensive return-to-sport assessment that includes both physical and psychological factors to determine your readiness to return to sport. This involves functional testing, strength and stability assessments, and psychological readiness measures.

Remember, a return to sport is not just about meeting a specific timeline but about ensuring that your knee is ready to meet the demands of your sport. Your safety and long-term athletic success are paramount.

Returning to sport after ACL reconstruction is a complex process, influenced by many variables. A premature return can lead to serious setbacks, including a higher risk of reinjury. It’s important to trust the recovery process and work closely with experts like Dr. Ben Mayo, who can guide you based on your unique needs and recovery progress.