Returning to sport after an ACL injury depends on the knee regaining strength, stability and movement control, not on time passing alone. This guide explains the stages and the criteria your surgeon and therapist use to decide when you are ready.
Note: This is general information. Your surgeon and therapist decide your return after an in-person assessment.
Signs you may be ready
A return to sport may be considered when signs like these are met:
- No swelling or pain during activity
- Full knee movement regained
- Thigh and leg strength close to the other leg
- The athlete trusts the knee
- Good movement control when jumping, landing and changing direction
- Passing tests set by the surgeon and therapist
Why is return based on criteria?
Why is time alone not enough?
- Every patient recovers at a different pace
- A wound can look healed while the muscles are still weak
- Returning early, before the stages are complete, is one of the main reasons injuries recur
- Different sports demand different things of the knee
How is readiness assessed?
The surgeon and therapist judge readiness through a knee examination, muscle strength measurements, stability checks and tests of jumping, landing and changing direction. This is an assessment of you personally and cannot be done remotely. For a general overview, read a safe return to sport.
The return programme
Non-surgical treatment
After an ACL injury, whether treated with or without surgery, return is built on a graded rehabilitation programme.
- Ongoing muscle-strengthening exercises
- Landing and movement-control training
- Neuromuscular training to help prevent re-injury
- A brace if your doctor recommends one
Surgical treatment
If you had ACL reconstruction, your return programme follows your surgeon's plan, which takes into account the type of operation and any related injuries. Please do not alter the programme yourself.
Recovery and rehabilitation
Return moves through stages, and you do not advance until you have passed the one before. How long this takes varies from person to person and is set by the surgeon after assessment. See also knee rehabilitation.
- Controlling pain and swelling
- Restoring knee range of motion
- Strengthening the muscles around the joint
- Balance and movement-control exercises
- Running, then sport-specific movements
- A gradual return to training, then competition
When to see the doctor
Stop training and contact your surgeon if:
- Swelling or pain returns after activity
- The knee feels like it gives way
- There is a new pop or twist injury
- The knee locks or loses movement
- You feel fearful of movements despite improving