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Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review
  1. Alexandre J M Rambaud1,2,
  2. Clare L Ardern3,4,
  3. Patricia Thoreux5,6,
  4. Jean-Philippe Regnaux7,8,
  5. Pascal Edouard1,9
  1. 1 Inter‐University Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France
  2. 2 Physiotherapy Clinic of the Sport Center, La Talaudière, France
  3. 3 Division of Physiotherapy, Linköping University, Linköping, Sweden
  4. 4 School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  5. 5 Orthopaedic Department and Sport Medicine Unit, APHP-University Paris, Bobigny, France
  6. 6 Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
  7. 7 French School of Public Health (EHESP), Paris, France
  8. 8 Inserm U1153, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS), Paris, France
  9. 9 Sports Medicine Unit, Department of Clinical and Exercise Physiology, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
  1. Correspondence to Alexandre J M Rambaud, Inter‐University Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, Saint-Priest en Jarez 42270, France; alexandre.rambaud.kine{at}


Objective To describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction.

Design Scoping review.

Data sources The MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORTDiscus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking.

Eligibility criteria for selecting studies Reported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively.

Results 201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5–39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or >95% of the non-injured knee plus no pain or pain <2 on visual analogue scale; isometric extensor limb symmetry index (LSI)>70% plus extensor and flexor LSI>70%; and hop test LSI>70%.

Conclusions Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction.

  • anterior cruciate ligament
  • running
  • review
  • knee surgery

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  • Contributors All authors have contributed to the development of the research questions and study design. AJMR, PE and JPR identified the method of the scoping protocol. AJMR and PE developed and conducted the search strategy and data extraction. All authors developed the first and subsequent drafts of the manuscript. All authors reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been updated since it was published Online First. The title has been corrected in order to fix a grammatical error.