4 Tips for Returning to Play After an ACL Reconstruction

One of the most common traumatic knee injuries in sports is an anterior cruciate ligament (ACL) sprain or tear.¹

The ACL is a major ligament that helps to stabilize the knee joint. Athletes and recreational enthusiasts of all ages can experience an ACL tear, especially those who participate in high demand sports like soccer, football, volleyball and basketball.¹ After surgery, athletes tend to be very anxious to get back to the sport they love. To help them get back to their sport safely with minimal risk of re-injury, Athletico developed an ACL 3P Program. The three “P’s” stand for prevention, progression and performance. The performance aspect of the program emphasizes limb symmetry, proper landing/cutting mechanics and match fitness to minimize the athlete’s risk for re-tear. Learn more about the program by reading Athletico’s “Can ACL Tears Be Prevented?” blog.

Evidence suggests that an athlete may be 30 percent likely to re-tear an ACL, 20 percent on contralateral leg and 10 percent on same leg². Athletico’s program aims to lower that risk by making sure an athlete has good landing and cutting mechanics when fatigued. Here are the top four things to consider before returning to play after an ACL-Reconstruction.

1)  Timing isn’t everything

A decade ago, most patients were discharged from physical therapy around the three month mark, then released by their physician to return to play at the six month mark. Instead of a time-based criteria, evidence suggests more objective criteria. Athletico’s ACL 3P program includes a cluster of tests – Y balance testing, hop testing, and video analysis of cutting and landing tasks to determine an athlete’s readiness to return to play. Educating patients from the first day of post-op about criteria-based return to play instead of returning right at the six month post-op mark will help them have realistic expectations.

2) Hop testing alone is NOT sufficient

A recent article came out suggesting that hop testing by itself is insufficient to allow an athlete to return to play.³ If hop testing is the only criteria for return to play, the athlete has been done a disservice. Other objective, sport-specific criteria should also be used.

Similarly, power is one of the last items to come back. Athletico includes single leg, triple hop testing in the “prevention” screen so that we have a baseline on athletes. If that athlete ever has an injury, Athletico clinicians can make sure that athlete not only returns to their baseline, but exceeds it.  Athletes often demonstrate symmetry by the 6six month post-op mark. However, their power often doesn’t return until the 7-8 month post-op mark.  By having a baseline, Athletico clinicians can ensure athletes are not only symmetrical but re-gain power as well.

3) Fatigue

Athletico’s final RTP phase includes a five minute fatigue protocol. Because athletes are most likely to get injured when they are tired, Athletico ACL 3P clinicians want to ensure that landing and cutting mechanics are flawless when fatigued⁴. This is a key differentiator of Athletico’s program.

4) Athletes should not expect to play in a tournament their first weekend back in contact

Patients are often allowed to return to non-contact practice participation before the six month mark, or before they pass all return to play criteria under fatigue. This allows the athlete to start getting some sport-specific muscle memory and fitness. Many parents and athletes think that “getting released” means they can go back to playing a 90-minute soccer match (or even worse – an entire tournament) the first week back. To ensure safe progression, when “released,” athletes should participate in several weeks of full contact practices before trying just a few minutes in each half of a match.  Physical therapists work hard to mimic sport-specific movements in physical therapy, but reactive decision-making is difficult and best replicated during practice and games. This can fatigue athletes quickly. Educating patients about appropriate progression is key to minimizing their risk for re-injury!

Returning To Play!

If you are interested in Athletico’s ACL 3P Return to Play testing, please email ACL@athletico.com.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

1. “Anterior Cruciate Ligament (ACL) Injuries.”OrthoInfo. American Academy of Orthopaedic Surgeons, 01 Mar. 2014. Web. 02 May 2017. <http://orthoinfo.aaos.org/topic.cfm?topic=a00549>.
2. Paterno et al. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. Am J Sports Med. 2014; 42(7): 1567-1573.
3. Hoog et al. Functional hop tests and tuck jump assessment scores between female division 1 collegiate athletes participating in high vs low ACL injury prone sports: a cross sectional analysis. IJSPT. 2016; 11(6): 945-953.
4. Quammen et al. Two Different Fatigue Protocols and Lower Extremity Motion Patterns during a Stop-Jump Task. Journal of Athletic Training. 2012; 47(1):32-41