From the Guidelines
Return to elite sport competition after ACL reconstruction typically takes 9-12 months, though this timeline can vary based on individual factors, with the most recent and highest quality study suggesting a minimum criteria for return to sport including no pain or swelling, full knee range of motion, and normalized subjective knee function and psychological readiness 1. The rehabilitation journey begins immediately after surgery with a focus on reducing swelling and restoring range of motion. As healing progresses, physical therapy advances through phases including strength training, neuromuscular control exercises, sport-specific drills, and finally return-to-sport testing. Some key points to consider in the rehabilitation process include:
- The use of a test battery to determine the moment of return to play, including strength tests, hop tests, and measurement of quality of movement 1
- The importance of psychological readiness, with fear of reinjury being a significant contributor to not returning to sport 1
- The need for a transition phase from sports participation to sports performance with progressive and controlled exposure to the athlete's sport 1
- The use of exercise interventions as the foundation of ACLR rehabilitation, with a focus on strength and motor control training 1 The lengthy recovery period is necessary because the reconstructed ligament undergoes biological remodeling called "ligamentization," which takes months to complete. Additionally, the athlete needs time to rebuild strength, coordination, and confidence. Some sports may require longer recovery periods due to their specific physical demands, with pivoting and cutting sports like soccer and basketball often requiring the full 12 months or longer. It is also important to note that around 80% of ACL-reconstructed patients return to some kind of sporting activities, but only 65% return to their preinjury level and 55% to competitive level sports, highlighting the importance of a well-structured rehabilitation program 1.
From the Research
Return to Play Timeline for Elite Athletes after ACL Reconstruction
- The typical return to play timeline for elite athletes after Anterior Cruciate Ligament (ACL) reconstruction can vary depending on several factors, including the type of surgery, rehabilitation protocol, and individual athlete characteristics 2, 3.
- A study published in 2011 found that 67% of patients attempted some form of sports activity by 12 months postoperatively, while 33% attempted competitive sport 2.
- Another study published in 2024 reported that patients who underwent conservative treatment using platelet-rich plasma (PRP) therapy were able to return to their pre-injury level of sport in an average of 139.5 days 4.
- A review of ACL reconstruction in elite athletes found that the goal of returning to the same preinjury level of sport is often not met, with many athletes returning to a lower level of performance 3.
- A study published in 2022 reported that 87.8% of elite athletes achieved return to play after revision ACL reconstruction, with 75.5% returning to the same level of competition 5.
Factors Affecting Return to Play
- The presence of meniscal and chondral pathology can affect return to play rates and competition levels after revision ACL reconstruction 5.
- Athletes with <50% thickness or no articular cartilage lesions were more likely to return to play and return to the same competition level compared to those with ≥50% thickness chondral lesions 5.
- Medial meniscal pathology was associated with lower competition level at return to play 5.
Return to Sport Rates
- A systematic review published in 2019 reported that the rate of return to sport at any level ranged from 56% to 100%, while the rate of return to sport at preinjury level ranged from 13% to 69% 6.
- The average time to return to sport ranged from 6.7 to 12 months, with patient-reported outcome scores showing improvement at follow-up from preoperative scores 6.