This prospective 2-year cohort study of 106 ACL-reconstructed athletes asked whether timing of return to sport and functional readiness affect reinjury risk. It quantified the independent contributions of sport level, time from surgery, and knee function prior to return.
Before this paper, return-to-sport decisions after ACL reconstruction were largely time-based and intuitive, with no clear functional thresholds tied to actual reinjury outcomes. The 6-month clearance commonly used in practice had no prospective data showing it reduced reinjury risk.
This study gives you two concrete rules to use with every ACL patient: do not clear for level I sport before 9 months, and do not clear without quadriceps LSI approaching 90%. When a 20-year-old soccer player pushes for early return at 5-6 months, this paper is why you say no — the reinjury rate before 5 months was 100%, and every month gained before 9 months cuts risk by half.
The 84% lower reinjury rate with full RTS criteria passage is clinically striking even without statistical significance, given only 18 patients passed. Underselling it because of p=0.075 would be a mistake. The takeaway for practice: time and quad strength together form the minimum clearance standard, and patients who return before achieving both are accepting a dramatically elevated reinjury and OA risk.
This prospective 2-year cohort study of 106 ACL-reconstructed athletes asked whether timing of return to sport and functional readiness affect reinjury risk. It quantified the independent contributions of sport level, time from surgery, and knee function prior to return.
Before this paper, return-to-sport decisions after ACL reconstruction were largely time-based and intuitive, with no clear functional thresholds tied to actual reinjury outcomes. The 6-month clearance commonly used in practice had no prospective data showing it reduced reinjury risk.
This study gives you two concrete rules to use with every ACL patient: do not clear for level I sport before 9 months, and do not clear without quadriceps LSI approaching 90%. When a 20-year-old soccer player pushes for early return at 5-6 months, this paper is why you say no — the reinjury rate before 5 months was 100%, and every month gained before 9 months cuts risk by half.
The 84% lower reinjury rate with full RTS criteria passage is clinically striking even without statistical significance, given only 18 patients passed. Underselling it because of p=0.075 would be a mistake. The takeaway for practice: time and quad strength together form the minimum clearance standard, and patients who return before achieving both are accepting a dramatically elevated reinjury and OA risk.