Myer et al. proposed four stages of advanced rehabilitation protocol to address common deficits found in athletes after ACL-reconstruction:

Stage 1: Dynamic stabilization and core strengthening

Stage 2: Functional strengthening

Stage 3: Power development

Stage 4: Sports performance symmetry

A systematic review by Barber-Westin et al, investigated return to sport criteria in many studies and concluded that in order to give clearance to return to sport an athlete must have:

• Less than 10% deficit in strength of the quadriceps and hamstring on isokinetic testing at 180°/s and 300°/s,

• Less than 15% deficit in lower limb symmetry on single-leg hop testing (single hop, triple hop, crossover hop, and timed hop)

• Less than 3 mm of increased anterior-posterior tibial displacement on Lachman or knee arthrometer testing,

• Greater than 60% normalized knee separation distance on a video drop-jump test,

• Absence of effusion

• Full knee ROM

• Normal patellar mobility,

• No or only slight patellar crepitus,

• Painless activities without swelling.

A review by Davies et al. (2020) suggests that completing only the single leg hop for distance and the triple single leg hop is a sufficient assessment. The review also recommends including additional hop tests such as vertical hop, vertical hop and rebound or lateral hop which may provide additional information regarding RTS readiness. 

By Lee Poole.