Returning to sport after ACL reconstruction is a complex process that extends well beyond healing from surgery. Hadley et al. highlights the importance of a structured, criteria-based approach to return to play, emphasizing that athletes should demonstrate adequate physical readiness, movement quality, and psychological confidence before resuming sport. Rather than relying solely on time since surgery, clinicians and athletes should consider a combination of strength, functional performance, and sport-specific demands when making return-to-play decisions. Understanding these factors can help athletes navigate the rehabilitation process while reducing the risk of reinjury and supporting a safe, confident return to competition.
The Hadley et al. (2022) study developed a 7-item return-to-play (RTP) checklist after ACL reconstruction. An athlete needed to pass at least 6 of the 7 criteria to be cleared for return to their preinjury level of activity.
Hadley et al. ACL Return-to-Play Criteria
| CATEGORY | CRITERION | PASSING STANDARD |
| Physical exam | Effusion | No knee effusion |
| ROM | Full range of motion | |
| Stability | No instability | |
| Thigh circumference | < 1.5 cm difference from uninvolved side | |
| Functional/kinematic testing | Functional Movement Screen (FMS) | >14 |
| Hop testing | >90% limb symmetry on all 4 hop tests | |
| Pro Agility test | >90% of contralateral side | |
| Movement assessment | >80% of contralateral side | |
| Patient-reported function | IKDC questionnaire | >90% |
Why it matters
Hadley et al. found that patients who passed the checklist before returning to sport had a significantly lower rate of ipsilateral knee injury over the subsequent 2 years. Ipsilateral injury occurred in 5.5% of those who passed versus 18.4% of those who did not pass (P = .017).
The key takeaway for a newsletter would be:
Return to play after ACL reconstruction should not be based on time alone. Hadley et al. support using a combination of physical examination, functional performance, movement quality, and patient-reported function to determine whether an athlete is ready to return
Contact your local Apple Therapy location for your ACL RTP Test!
