Are athletes ready to return to competitive sports following ACL reconstruction and medical clearance?

Abstract Return to sports after anterior cruciate ligament reconstruction (ACLR) is often based on medical clearance and the rehabilitation teams’ decision regarding the physical readiness of athletes. However, re-injury and contralateral injuries are increasing. The purpose of the study was to assess the readiness for return to sport in a sample of division III athletes following ACL reconstruction. Twenty-one collegiate athletes (7 males and 14 females) with ACLR and medical clearance to return to sport were recruited. The functional performance of the athletes and the symmetry of both lower extremity measures were evaluated using motion/force-plate analysis, balance, core strength/endurance and functional knee performance testing. Athlete performance reports were provided with training suggestions. The operated lower extremities had a significant decrease in vertical ground reaction force, less knee flexion and more valgus during a single-leg landing task, lower balance scores and reduced hop distance for the majority of participants. Participants continued to show a reduction in operated legs’ performance despite being medically cleared for sports. Lasting deficiencies and their magnitude may explain the increased tendencies for re-injury following ACLR as reported in the literature. Safe return to sport following ACLR should be based on achieving symmetry of performance of lower extremities. A thorough assessment of an athlete’s performance using a comprehensive examination can identify deficiencies and can be used to guide clinical decision-making.