Authors estimate over 100,000 ACL reconstructions are performed in our country each year. With equal incidence of early arthritis in both conservatively treated and surgically repaired ACLs the main reason for these surgeries would be to improve an athlete’s ability to return to their prior levels of sport. In prior decades, professional athletes who benefited from their athletic abilities, effort, top Physical Therapy providers, access to care, and financial resources attempted to rush back (3-4 months) from ACL reconstruction only to sustain an injury to their involved or uninvolved knees. We have learned over the decades that delaying an athlete’s return to sport allows them additional healing and time for Physical Therapy in order to regain an optimal amount of strength, power, agility, balance, and sport specific movements. Previous studies have shown delaying a return to sport to a 9-12 month window reduced a risk of another injury by 85%. A recent study supports the utilization of a longer rehabilitation time frame to reduce the risk of another ACL injury.

Beischer and colleagues published their findings on risk of a 2nd ACL injury in the Journal of Sports Physical Therapy (2020). They aimed to determine the impact of return to sport timing and muscle performance symmetry on risk of injury. They followed 159 athletes who returned to sport after ACL reconstruction. Authors reported higher rates of re injury in athletes who had greater disability before surgery and a faster return to sport. Surprisingly, symmetrical muscle function and strength were no associated with a 2nd ACL injury. Importantly, athletes who returned to sport before 9 months after surgery were 7x more likely to sustain a second ACL injury. This study adds to our understanding on advising athletes on return to sport after ACL injury. Although many questions remain as to why so many athletes sustain a second injury to their involved or un involved knees delaying a return to sport may allow the Physical Therapist and athlete more time to resolve known or unknown risk factors.

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