Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review

Br J Sports Med. 2019 Sep;53(18):1154-1161. doi: 10.1136/bjsports-2018-099982. Epub 2019 Feb 2.


Objective: To describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.

Design: Scoping review.

Data sources: MEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS.

Eligibility criteria: Prospective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft.

Results: In total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%).

Summary: Time and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid-do they predict successful RTS?-is largely unknown.

Keywords: acl; testing.

Publication types

  • Systematic Review

MeSH terms

  • Anterior Cruciate Ligament Injuries / physiopathology
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation*
  • Athletic Injuries / surgery*
  • Athletic Performance / physiology
  • Exercise Test
  • Humans
  • Muscle Strength / physiology
  • Patient Reported Outcome Measures
  • Recovery of Function
  • Return to Sport*
  • Time Factors
  • Transplantation, Autologous