The Outdated Time-Based Approach
For decades, athletes were cleared to return to sport based on a calendar (6 months post-ACLR, 6 weeks post-hamstring strain). Research now conclusively shows time is a poor proxy for readiness. Criterion-based return is safer and produces better outcomes.
Physical Readiness Criteria
Strength symmetry (90%+ limb symmetry index on isokinetic dynamometry), hop test performance (single-hop, triple-hop, crossover-hop), and movement quality (landing mechanics, hip-knee alignment) must all be assessed.
Functional Sport-Specific Testing
Deceleration, change of direction, reactive agility, and sport-specific movement patterns must be performed at full speed without pain, apprehension, or compensatory movement before unrestricted return.
Psychological Readiness
The ACL Return to Sport after Injury (ACL-RSI) scale measures confidence, emotions, and risk appraisal. Athletes with low scores have 3x higher re-injury rates regardless of physical test results. Psychological preparation is not optional.