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ACL Return to Sport
Knee readiness check after ACL reconstruction

Updated August 17, 2026

Tool

Knee readiness check after ACL reconstruction

Nine criteria drawn from the return-to-sport literature, grouped the way a clinic groups them, with a printable summary and a shareable link at the end. It does not clear you to play. It tells you which conversation to have.

Nine criteria, checked honestly

Tick what is actually true today, not what you expect to be true next month. Nothing you enter leaves your browser, and the link at the bottom carries your answers so you can send this to your physical therapist.

Where these nine come from

They are the components that recur across the cohorts that actually reported outcomes: time since surgery, measured quadriceps and hamstring symmetry, hop test symmetry, a quiet joint with full motion, movement quality on landing, and psychological readiness. Each one carries the study it came from in its own hint text, and all of them are listed with PubMed identifiers on the sources page.

How to use the result

1

The print button produces a one-page summary with the header, footer and navigation stripped out. A clinician reading a list of nine criteria will get to the point faster than one listening to how your knee feels.

2

The copy button gives you a URL that carries your answers. Nothing is stored on a server; the answers are encoded in the link itself, which is why it works and why it is private.

3

Rerun it monthly

A single snapshot at month six is a lot of weight on one afternoon. Three runs at months five, seven and nine show you whether the gaps are closing, which is the more useful question.

4

Fix the unchecked boxes, do not argue with them

Every unchecked criterion is a measured deficit and a few weeks of specific work. None of them are permanent.

What this check is not

It is not clearance. Clearance is a clinical decision made by a physician, usually with a physical therapist and an athletic trainer, and it depends on things this page cannot see: what your surgeon found in your knee, whether your meniscus was repaired, your sport, your position and your age.

It also cannot promise anything, and the literature is clear about that. A meta-analysis of four studies found the pooled risk difference for passing return-to-sport criteria was -3% and not statistically significant, with 14.4% of those who passed still sustaining a second ACL injury, at very low quality of evidence. Meanwhile in the Delaware-Oslo cohort 38.2% of those who failed were reinjured against 5.6% of those who passed. Both of those are true. Checking nine boxes is how you find the deficits, not how you buy safety.

References cited on this page

Every figure on this page comes from one of the publications below. The level of evidence is stated: a national guideline, a meta-analysis and a case series do not carry the same weight.

  • Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine, 2016;50(13):804-808. PubMed 27162233. 106 pivoting-sport patients, prospective two-year cohort.
  • Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 2016;50(15):946-951. PubMed 27215935. 158 male professional athletes, median follow-up 646 days.
  • Losciale JM, Zdeb RM, Ledbetter L, Reiman MP, Sell TC. The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, 2019;49(2):43-54. PubMed 30501385. Systematic review, 4 studies, meta-analysis.
  • Sturgill LP, Snyder-Mackler L, Manal TJ, Axe MJ. Interrater reliability of a clinical scale to assess knee joint effusion. Journal of Orthopaedic and Sports Physical Therapy, 2009;39(12):845-849. PubMed 20032559. 75 test pairs, two therapists.
  • Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. American Journal of Sports Medicine, 2014;42(7):1567-1573. PubMed 24753238. Cohort of athletes followed for 24 months after their return, with healthy controls.
  • McPherson AL, Feller JA, Hewett TE, Webster KE. Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. American Journal of Sports Medicine, 2019;47(4):857-862. PubMed 30753794. 329 patients back in sport, ACL-RSI score.
  • Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Physical Therapy in Sport, 2008;9(1):9-15. PubMed 19083699. Scale development and preliminary validation. The ACL-RSI scale measures confidence, apprehension and fear of reinjury: it puts a number on the psychological side of returning to sport.
  • Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 2023;57(9):500-514. Read the publication. Clinical practice guideline built with the GRADE method: progression driven by objective criteria rather than the calendar alone, early strengthening, explicit criteria for returning to running and to sport.

See the full bibliography

Questions people actually ask

Does this tell me if I can play?
No. It tells you which of nine criteria you currently meet and which you do not, so the clearance conversation starts from measurements instead of impressions. The decision belongs to a physician who can examine your knee.
Why is time since surgery one of the criteria?
Because it is the finding that holds up most consistently. Reinjury fell 51% for each month return was delayed up to nine months in the Delaware-Oslo cohort, and returning to knee-strenuous sport before nine months carried a hazard ratio of 6.7 in a Swedish registry cohort.
What if I meet eight of nine and the missing one is time?
Then your knee tests like a cleared knee and your calendar does not, and the tool says so explicitly. That is the single most common profile among people who get reinjured after passing testing.
Is anything I enter stored?
No. The calculation runs in your browser and the answers live in the page address, which is why the shareable link works. Close the tab and there is nothing left anywhere.

Recovery tracking app

Where does your knee actually stand?

ACL Return to Sport plots the numbers this page keeps pointing at: your strength figures, your four hop tests, your ACL-RSI and your effusion grade, against the thresholds, from week one to two years. One email address, two messages at most before launch.

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