ACL Reconstruction — Return to Sport Testing

⚙️What This Procedure Involves

RTS testing typically includes: isokinetic dynamometry — quadriceps and hamstring strength measured on a machine, comparing the operated leg to the non-operated leg (limb symmetry index, LSI). Target: greater than 90% LSI. Hop testing — single hop for distance, triple hop, crossover hop, and timed 6-metre hop. Target: greater than 90% LSI. Functional testing — Y-balance test, single-leg squat quality, agility tests, and sport-specific drills. Psychological readiness — ACL-Return to Sport after Injury (ACL-RSI) questionnaire. Target: score greater than 56/100. The assessment takes approximately one hour and is performed by a physiotherapist experienced in ACL rehabilitation.

💡Why It May Be Recommended

Athletes who pass RTS testing criteria before returning to sport have a significantly lower re-rupture rate than those who return based on time alone. Simply waiting nine to twelve months does not guarantee readiness — objective criteria must be met.

⚖️Non-Operative Alternatives

Time-based return (e.g., 'return at nine months') — this is inferior to criteria-based return and is associated with higher re-injury rates.

📋Preparing for Surgery

Not a surgical procedure. Performed at nine to twelve months post-ACL reconstruction. Requires access to isokinetic dynamometry and a structured testing protocol.

✅Expected Benefits

Athletes who meet all RTS criteria have approximately 60% lower re-rupture rates. The testing identifies specific deficits that can be targeted with additional rehabilitation before clearance.

⚠️Common Risks

• Delayed returnCommon

  Athletes who do not meet criteria must continue rehabilitation before retesting. This may be frustrating but reduces re-injury risk.

• False reassuranceExpected

  Passing RTS testing does not eliminate re-injury risk — it reduces it. Re-rupture rates are approximately 6% even with testing.

🔴Less Common but Serious Risks

• Provocative testingRare

  The hop tests place load on the reconstructed ACL. There is a theoretical (very low) risk of graft injury during testing. Not reported in the literature.

💉Anaesthetic Considerations

No anaesthesia needed.

🏃Recovery and Rehabilitation

If criteria are met: graduated return to sport over four to six weeks (training → non-contact → contact → competition). If criteria are not met: targeted rehabilitation addressing specific deficits, with retesting at four to six week intervals.

📅Follow-Up

Retesting every four to six weeks until all criteria are met. Ongoing neuromuscular training (FIFA 11+, injury prevention programme) after return to sport — indefinitely.

❓Frequently Asked Questions