Critical Criteria Recommendations: Return to Sport After ACL reconstruction requires evaluation of time after surgery of 8 months,2 functional tests, psychological readiness, and quadriceps/hamstring strength

The purpose of this study was to examine the factors commonly used to determine readiness for RTS in the ACL-R patient population and assess which were most influential to successfully returning to sport and avoiding re-tear.The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol. Data of interest was extracted and studies were stratified based on level of evidence and selected study features. Meta-analysis and/or subjective synthesis of appropriate studies was used to assess over 25 potentially significant variables effecting RTS and re-tear.After initial search of 1503 studies, 47 articles were selected for inclusion in the final data analysis including a total of 1432 patients (31.4% females, 68.6% male). A meta-analysis of re-tear rate for included Level of Evidence 1 studies was calculated to be 2.8%. Subgroups including protocols containing a strict time until RTS, strength testing, and ≥2 dynamic tests demonstrated decreased RTS and re-tear heterogeneity from the larger group. Time to RTS, strength testing, dynamic functional testing, and knee stability were also found to be among the most prevalent reported criteria in RTS protocol studies.This study suggests a multifactorial clinical algorithm for successful evaluation of RTS. The "critical criteria" recommended by the authors to be part of the postoperative RTS criteria include time since surgery of 8 months, use of2 functional tests, psychological readiness testing, and quadriceps/hamstring strength testing in addition to the modifying patient factors of age and female gender.Level IV, Systematic Review of Level IV or better investigations.