One of the most controversial topics in professional sports today is when should an athlete return to play? Here at St. George Physiotherapy we wanted to make this information relevant to the average person…the 17 year old female soccer player, the 18 year old wide receiver, the 30 year old weekend warrior playing summer baseball or winter hockey.
There are many factors to consider: age of athlete, type of repair (patellar or hamstring graft), sport to return to, level of sport returning to, other injuries in the knee, access to rehabilitation facilities, budget for rehabilitation, psychological preparedness to play. It becomes easy to see why a professional NFL player is back playing in 9 or 10 months and some individuals do not get back to their sport for 18-24 months.
In general, professional athletes (NFL and CFL players) with ACL repairs studied in the early 2000’s were returning on average 10.4 months post surgery(1). In highschool students, considerations need to be made for the developing body and puberty. Studies have shown that return to sport before 9 months post-op in this population is associated with a high rate of re-injury. One interesting statistic is that in each month that return to sport was delayed before 9 months decreased re-injury rate by more than 50%!(2). Sports that require contact and/or pivoting will require more caution and therefore usually delay return.
The bottom line is that there is no consensus on an exact timeline. Instead, most return to sport guidelines rely on a combination of time post-operatively as well as objective measurements of knee function (thigh circumference measures, quad strength, single leg hop test, etc) that compare to the uninvolved side. As well, the psychological state of the individual with respect to their readiness to return cannot be overstated. A strong leg on an athlete that is constantly worried about re-injury in the game will be at a greater risk of injury than the confident athlete whose leg is strong.
In conclusion, there is no definitive time to return to sport following ACL repair. The best timelines will be adjusted based upon response to treatment, physical measures, performance measures, type of sport and level of play. Your physiotherapist and surgeon will collaborate to determine each individual's unique time frame.
1 Am J Sports Med. 2020 Jun;48(7):1682-1688
2 Elsevier Volume 4, Issue 1, January 2022, Pages e221-e230