Article Text

other Versions

Download PDFPDF
Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review
  1. Ciara R Burgi1,
  2. Scott Peters2,
  3. Clare L Ardern3,4,
  4. John R Magill1,
  5. Christina D Gomez5,
  6. Jonathan Sylvain6,
  7. Michael P Reiman7
  1. 1 Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
  2. 2 Physical Therapy, Toronto Blue Jays Major League Baseball Club, Toronto, Ontario, Canada
  3. 3 Division of Physiotherapy, Linköping University, Linköping, Sweden
  4. 4 School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  5. 5 Department of Orthopedics and Sports Medicine, Houston Methodist Sugar Land Hospital, Sugar Land, Texas, USA
  6. 6 Hartford Healthcare Rehabilitaiton Network, Farmington, Connecticut, USA
  7. 7 Division of Physical Therapy, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Ciara R Burgi, Duke Sports Medicine Physical Therapy, Durham, NC 27710, USA; ciara.burgi{at}


Objective To describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.

Design Scoping review.

Data sources MEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS.

Eligibility criteria Prospective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft.

Results In total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%).

Summary Time and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid—do they predict successful RTS?—is largely unknown.

  • acl
  • testing

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CRB contributed to initial search, data extraction, initial drafting, review and editing of the manuscript. SP contributed to initial search, data extraction, initial drafting, review and editing of the manuscript. CLA contributed to initial drafting, review and editing of manuscript. JRM contributed to initial search, data extraction and review of manuscript. CDG and JS contributed to data extraction and review of manuscript. MPR contributed the idea of the manuscript, initial search, review of data, initial drafting, review and editing of the manuscript. All authors approved of final version of 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.

  • Data sharing statement Data available upon request.