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Upgraded hardware─What about the software? Brain updates for return to play following ACL reconstruction
  1. Dustin R Grooms1,2,
  2. Gregory D Myer3,4,5,6,7
  1. 1Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
  2. 2Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA
  3. 3Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
  5. 5Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
  6. 6The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  7. 7Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Gregory D Myer, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA; greg.myer{at}

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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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  • Twitter Follow Gregory Myer at @gregmyer11

  • 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.