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Writer's pictureMark Jamantoc

ACL REPAIR - How long should you wait before playing again?

As a physical therapist, I get this question often. Working with athletes of all ages, there are certain differences in timelines - but this includes a variety of factors. A high school athlete wanting to get back to another season of football and a 26 year old office worker who does crossfit or lifts regularly and runs recreationally are two very different worlds.

The short answer:


As a general rule, the average time for an athlete to return to sports after an ACL repair is generally around 9 to 12 months post-surgery, though this varies based on individual recovery rates, rehabilitation progress, and sport demands. Current evidence suggests that returning before 9 months may increase the risk of re-injury. However, some athletes with excellent strength, stability, and movement control may be cleared as early as 6 months.


The return-to-sport timeline is usually guided by a combination of objective criteria, including:


  1. Strength Tests including maximum force testing measurements.

  2. Hop tests including performance testing in the clinic.

  3. Psychological readiness, and the absence of knee pain or swelling.

  4. Most research now emphasizes a "criteria-based" rather than strictly "time-based" approach, as outcomes are generally better when athletes meet specific functional benchmarks rather than rushing to meet a timeline.


What are the specific studies that cite this return to sport timeline? What does the statistics out there look like?


Several key studies provide evidence for the recommended 9 to 12-month return-to-sport (RTS) timeline post-ACL reconstruction (ACLR), often emphasizing a criteria-based approach over a strict timeline. Here are some influential studies:


  1. Grindem et al. (2016)Study Title: "Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study"Findings: This prospective study found that athletes who returned to sports at 9 months or later post-surgery had a significantly lower re-injury risk. The study highlighted the importance of meeting functional criteria (strength and hop tests) before return to sport.


  2. Beischer et al. (2020)Study Title: "Young Athletes at Risk of Early Reinjury Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis"Findings: This meta-analysis of 48 studies showed a high rate of re-injury among athletes who returned to sport before 9 months post-ACLR. It supported waiting 9–12 months to reduce the risk, especially for younger athletes.


  3. Wellsandt et al. (2017)Study Title: "Risk for Knee Osteoarthritis After Anterior Cruciate Ligament Injury: A Systematic Review of Biological and Functional Risk Factors"Findings: This study found that early RTS (< 9 months) could elevate the risk of osteoarthritis in addition to re-injury. The researchers recommended criteria-based RTS protocols that emphasize functional recovery milestones over fixed timeframes.


  4. Kyritsis et al. (2016)Study Title: "Biomechanical Risk Factors for Secondary ACL Injury: Altered Hip Rotation Patterns in Male and Female Athletes Following ACL Reconstruction"Findings: This study investigated biomechanical risk factors, demonstrating that athletes who passed strength and stability tests after ACLR (often achievable around 9–12 months) had lower re-injury rates.


  5. Ardern et al. (2011)Study Title: "Return to Sport Following ACL Reconstruction Surgery: A Systematic Review and Meta-analysis of the State of Play"Findings: This early meta-analysis reviewed 48 studies and found that less than 50% of athletes returned to their pre-injury levels of sports at the 6-month mark, with better outcomes reported closer to 9–12 months.


These studies collectively support a minimum of 9 months post-ACLR before RTS, underscoring the importance of passing functional benchmarks to lower re-injury risks.



There is value in waiting and allowing that graft to be "integrated" as a part of your body. My advice is wait a minimum of 1 year to be safe. Seek a physical therapist or provider who understands these timelines and work with your coach to train towards getting back to playing. It is a matter of TEAM WORK!

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