ACL Return to Play Toolkit

Pediatric Anterior Cruciate Ligament (ACL) Return to Play (RTP) Toolkit

One out of every four young athletes returning to sports following treatment for an ACL injury will have a secondary ACL injury. Although graft healing is historically based on time estimates, a young athlete must also demonstrate functional healing (i.e. “readiness”) prior to returning to play.


Returning patients to pre-injury sport/activity is an important goal of treatment after pediatric ACL reconstruction.  Patients often “feel” ready to play sooner than objective, functional, or psychological findings may suggest.  This “toolkit” is meant to provide guidelines, resources, and a structure for returning young athletes to play.


An emphasis should be made to discuss a RTP strategy with patients and families both BEFORE surgery and when discussing readiness to return to sport/activity following ACL surgery or injury.

Return to Play Toolkit: 

 Pre-operative discussion about:

  • Importance of adherence to post-operative restrictions
  • Importance of adherence to post-operative rehab protocol
  • Align patient, family, and coach expectations
  • Pediatric patients are vulnerable population at INCREASED risk of re-injury after ACL-R particularly with early (<1 year) return to sport**

 Time from surgery >9 months

 Physical exam

 Patient reported outcome measures

Functional measure milestones (assessed and documented by licensed physical therapist): 

 Referral to ACL injury prevention program

 Appropriate Use Guidelines for ACL Prevention Program

Discussion of psychological factors related to return to sport

 Discussion of re-injury risk in pediatric/adolescent patients

Discussion of efficacy of ACL functional bracing