Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase

J Orthop Sports Phys Ther. 2006 Jun;36(6):385-402. doi: 10.2519/jospt.2006.2222.


Rehabilitation following anterior cruciate ligament (ACL) reconstruction has undergone a relatively rapid and global evolution over the past 25 years. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safe return to sport. Return-to-sport rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back into sport participation. The purpose of the following clinical commentary is to introduce an example of a criteria-driven algorithm for progression through return-to-sport rehabilitation following ACL reconstruction. Our criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patient-reported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks. Although this algorithm has limitations, it serves as a foundation to expand future evidence-based evaluation and to foster critical investigation into the development of objective measures to accurately determine readiness to safely return to sport following injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Algorithms
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Athletic Injuries / rehabilitation*
  • Humans
  • Knee Injuries / rehabilitation*
  • Knee Injuries / surgery
  • Physical Therapy Modalities
  • Plastic Surgery Procedures*
  • Progressive Patient Care
  • Recovery of Function
  • Sports Medicine
  • Time Factors