In return-to-sport decisions after ACL reconstruction, which criterion is commonly used?

• A. Time since surgery
• B. Limb symmetry index ≥ 90% on hop tests and strength testing with no pain or effusion
• C. Age
• D. ROM only

Answer: (B)

Return-to-sport decisions after ACL reconstruction are guided by objective functional criteria rather than just how long it’s been since surgery. The most widely used criterion is achieving limb symmetry of at least 90% on hop tests and on strength testing, with no pain or effusion. This means the operated leg should perform and measure nearly as well as the opposite leg in unilateral tasks that mimic sport demands, indicating adequate strength and power to handle cutting, jumping, and deceleration. Hop tests assess dynamic control, leg power, and confidence during single-leg tasks, while strength testing confirms the quadriceps and hamstrings have recovered sufficiently to stabilize the knee during high-demand activities. Pain and swelling absence ensures the knee is signaling readiness and not masking limits that could increase injury risk. Time since surgery or ROM alone can’t reliably predict readiness, and age isn’t a strong standalone predictor of return to sport.