ACL facts

Why important


– 70% of ACL injuries are non-contact injuries.

– 80,000 to 250,000 ACL injuries occur annually in the USA with about 100,000 reconstruction surgeries.

– 6th most common orthopedic procedure in USA.

– Female athletes are 2.4 top 9.7 times more likely to sustain an ACL injury than male athletes.

– Australia has one of the highest rates of ACL injury in the western world, compared to previously published nationwide and population incidences, including New Zealand (Gianotti et al., 2009), the United States (Csintalan, 2008; Lyman et al., 2009), Sweden (Granan et al., 2009), Norway (Granan et al., 2008) and Denmark (Lind et al., 2009).

Re-tear rates

Re-tear rates are between 20-25%.
This is mostly due to poor quality of care and understanding of what a full recovery looks like.

– As much as 30% of under 20 year olds will sustain a second ACL injury within 2yrs upon return to sport (compared to 5-10% of older age groups).

Ardern et al 2014

– Approximately 81% of patients return to any kind of sport, 65% return to their pre-injury level of sports participation and only 55% return to competitive sports.

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Krytsis et al 2016

These authors looked at 158 athletes and used the same key RTS performance criteria as mentioned above, with the addition of an agility drill (T-Test)

– All of the 158 athletes in this group returned to their previous competitive level of sport at an average of 229 days (approximately 8 months) post-op.

ter surgery.

– 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed.

– 26 players (16.5%) re-injured their graft at some point with 17 (65%) of them re-injuring their ACL within 6 months after RTS.

– Furthermore, 11 (7%) injured their other ACL.

– In regards to meeting performance criteria prior to RTS, 33% chose to RTS despite not meeting all 6 key criteria and subsequently reinjured their ACL.

– Only 10% of the players who did met all 6 criteria, and were passed fit to RTS, subsequently reinjured their ACL.

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Grindem et al 2016

These authors looked at 106 competitive athletes who recently had ACLR surgery and they had 5 key ACL return to sport testing performance criteria they wanted the player to achieve before clearing the player to RTS.
They were;

  • Quads strength within 10% of the uninjured side
  • 4 single leg hop tests; with no more than 10% difference between sides


– Patients who returned to level I sports had a 4.32 times higher reinjury rate than those who did not.

– The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery.

– 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed.

– Of the players who re-injured their ACL, 39% of them did so when they RTS earlier than 9 months, whereas 19% reinjured their ACL when they waited to RTS after 9 months

– Lastly, and is in fact no surprise, 4 of the subjects in this trial who RTS within 5 months of their ACLR (against medical advice), all subsequently re-injured their ACL within 2 months of playing sport.

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Feucht et al 2016

– Patient expectations of returning to the same level of sports are high: 91% of patients expect to return without problems.

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Greenberg et al 2018

– 56% of Physios surveyed used manual muscle testing as their only means of strength testing ACLR patients.

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Webster & Feller et al 2019

– 84% of non-professional ACLR athletes expected to return to sport by 12 months. 24% achieved this goal.

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Fältström et al 2021

– 42% of female football players who returned to sport after ACL reconstruction suffered a new ACL injury.

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