Before you play again after ACL surgery, pass strength, single-leg hop and cutting tests; the pain stopping or the months going by is not enough on its own. Dr. Ed runs the rehab in stages and retests you against what your sport demands before you go full speed.
Why a pain-free knee is not a ready knee
Pain going away is not the same as being ready to play. The injury that comes back is usually the one that was rested, felt fine and was never retested. So Dr. Ed does not go by how the knee feels, or by the calendar alone. He retests you.
The research points the same way. In a two-year study of 106 people who played pivoting sports after ACL reconstruction, the re-injury rate fell by 51% for each month return to sport was delayed until nine months after surgery, with no further drop after that (Grindem and colleagues, British Journal of Sports Medicine). More even strength in the quadriceps, the muscle on the front of the thigh, between the two legs before returning also lowered the re-injury rate.
That was one study of one group, so it is not a forecast for you. It does show that both time and thigh strength count. Dr. Ed tests each stage before the next one starts.
The tests, in plain terms
The studies behind this post tested strength, hops and running. The strength and hop tests set the leg that had surgery against your other leg.
- Strength.How hard the quadriceps, the muscle on the front of your thigh, can push, set against the other leg.
- Hops.Hopping on one leg for distance and for time, set against the other leg.
- Cutting.Planting your foot and changing direction at speed. Dr. Ed tests it if your sport calls for it.
Each test needs a pass mark. The Delaware-Oslo study used four single-leg hops: a single hop for distance, a triple hop for distance, a crossover hop for distance and a 6 m timed hop. It set the pass mark at above 90 on every test, and advised against full jumping, pivoting and hard-cutting sport until strength and hopping were back above 90% of the uninjured leg (Grindem and colleagues).
A second study followed 158 male professional athletes after ACL reconstruction. Before going back, they took a battery of strength, running and hop tests. Those who returned to team training without meeting all six discharge criteria had about four times the risk of tearing the graft (Kyritsis and colleagues, British Journal of Sports Medicine). All were professional men, so read it as a direction, not a forecast.
How Dr. Ed stages it
Dr. Ed works from your surgeon's protocol, not from a generic plan, and runs rehab in stages:
- Calm the injury.
- Restore range.
- Rebuild strength.
- Retest against what your sport demands: the single-leg hop, cutting, overhead load and backbends, whichever your sport asks for.
You know where you are at every visit and what the next gate is, the test you pass to move on. ACL recovery is a nine-to-twelve-month road for an athlete, done in stages and tested before each one. How long yours takes depends on the surgery and your surgeon's timeline, and Dr. Ed gives you a realistic answer at the evaluation and updates it as you progress.
Passing is not a promise that the knee will never be hurt again. It means the knee has met the demands of your sport in the clinic before it meets them in a game.
An ACL patient's own account is on the Reviews page.
Protecting the other knee
For athletes who have had an ACL injury, the same testing becomes a prevention program for the other side.
The numbers show why. A review of studies of younger athletes after ACL reconstruction found a second ACL injury in 15% overall: 7% in the knee that had surgery and 8% in the other knee. For athletes younger than 25 who returned to sport, the rate was 23% (Wiggins and colleagues, American Journal of Sports Medicine).
What to do next
Ask whoever clears you to play which tests you passed and by how much. For ACL rehab at Chatsworth Physical Therapy, see ACL recovery.