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Once quadriceps strength reaches 65% of the opposite leg, sports-specific activities may be performed; this usually occurs within 5-8 weeks postsurgery. This may be tested using a Cybex machine. The athlete may return to activity when the quadriceps strength has reached 80%, which is usually after at least 3-4 months of sports-specific therapy.

According to a study by Grindem et al, returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. The study also found that return to sport 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate.^[28]

A study by Kyritsis et al found that athletes who did not meet the discharge criteria before returning to professional sport had a four times greater risk of sustaining an ACL graft rupture compared with those who met all six return to sport criteria. The study also found that hamstring to quadriceps strength ratio deficits were associated with an increased risk of an ACL graft rupture.^[29]

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Media Gallery

Proper technique for the Lachman test.
Anterior drawer test: Note the anterior excursion of the tibia in relationship to the femur.
The pivot shift test.
MRI displaying a ruptured anterior cruciate ligament.

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Author

Matthew Gammons, MD Assistant Clinical Professor, Department of Family and Community Medicine, Medical College of Wisconsin; Medical Director, Castleton State College; Consulting Staff, Vermont Orthopaedic Clinic and Killington Medical Clinic

Matthew Gammons, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Society of Mechanical Engineers

Disclosure: Received income in an amount equal to or greater than $250 from: Up to Date.

Coauthor(s)

Evan Schwartz, MD Director of Orthopedic Surgery, St John's Queens Hospital, New York Medical College; Assistant Professor, Department of Surgery, Albert Einstein School of Medicine

Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author John D Hubbell, MD, to the development and writing of this article.

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