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The ‘release for full activity’ or the determination of ‘return to sport’ (RTS) is an important landmark for any athlete following anterior cruciate ligament reconstruction (ACLR). The ‘clearance’ to RTS following ACLR is not the golden ticket back to safe and successful preinjury level activity. Unfortunately, the ‘cleared’ status is accompanied by an up to 40-fold elevated risk of second ACL injury (relative to peers without a history of ACL injury) despite accepted ‘time’ postsurgery.1
Why rely on ‘time’ as a clearance criterion?
The reliance on time since surgery is too common, with the majority of investigations using time postoperative as a key criterion for RTS. Even more concerning, one-third of the investigations indicated that time from surgery was the only determinant for RTS decision-making.2 The insistence of a time-based and accelerated RTS may be heightened with pressures from coaches, parents and/or teammates to meet specific sport timelines. However, reliance on time as distinct from function to drive sport reintegration contributes to the gap between the athletes' perceived versus actual sports readiness.
Enough of graft type, tunnel placement and anchor strategies
Historically, little attention has been focused on late-phase rehabilitation …
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Funding National Institutes of Health/NIAMS (grant numbers R21AR065068-01A1 and U01AR067997).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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