Cleared vs Ready: What’s the Difference After ACL Reconstruction?

An ACL (anterior cruciate ligament) tear is one of the most dreaded injuries during a sport requiring pivoting, cutting, jumping, and landing. For many athletes, reconstruction surgery followed by rehabilitation is the path forward. But, returning to your sport is not just a function in time, it requires meeting strength, performance, neuromuscular, and psychological benchmarks to reduce re-injury risk and to maximize performance. In this blog, we’ll walk through:

1. What to expect from ACL reconstruction and rehabilitation

2. Key strength and functional tests before “returning to sport”

3. Criteria, timing, and “readiness”- when is it safe to return to sport

ACL Reconstruction & Rehabilitation: What to Expect

The Basics: Surgery and Healing

• ACL reconstruction typically uses a graft (patellar tendon, hamstring tendons, quadriceps tendon, or allograft) to replace the torn anterior cruciate ligament.

• After surgery, the graft needs biologic integration, remodeling, and gradual loading. Rehab protocols must balance protecting the graft in the early phases versus providing stimulus to promote tissue maturation and neuromuscular recovery.

• Return to Sport typically takes place at 9-12+ months. But timing greatly depends on the graft type, surgeon preferences, individual variation, and extent of injury.

Strength and Functional Tests Before Return to Sport:

Here are the most validated measures used by physical therapists before approving return to sport:

1. Limb Symmetry Index (LSI): 

   1. Your surgical leg shoulder reach >90% of the non-surgical leg

2. Strength Tests:

   1. Quadriceps strength test:

      1. Isokinetic or handheld dynamometer must must >90% LSI

   2. Hamstring strength test:

      1. >90% LSI to ensure joint stability and reduce risk of graft strain

3. Hop Test Battery:

   1. Single hop distance, triple hop distance, crossover hop, 6m timed hop

      1. Each score should be at least 90% of the non-surgical leg

4. Y-Balance or Star Excursion Test:

   1. Assesses dynamic balance and stability under single-leg load

5. Psychological Readiness (ACL-RSI Scale):

   1. A validated questionnaire measuring confidence and fear of re-injury. Athletes who score >65 tend to have a higher return-to-sport success rate.

Why Passing Strength Tests MATTERS:

Returning to sport based ONLY on a timeline ignores major differences in how each athlete heals and regains strength. Studies show:

1. Athletes who fail to meet at least >90% LSI have up to 4x HIGHER RISK OF A SECOND ACL INJURY

2. Quadriceps weakness remains one of the most persistent 

So.. How Do You Know You’re Ready?

Common questions to ask yourself and your therapist:

1. Can I hop, land, and cut off one leg just as well as the other?

2. Is my strength at least 90% symmetrical?

3. Do I move with confidence– not hesitation?

4. Have I practiced sport-specific movements at full speed?

5. Am I mentally ready to play without fear of re-injury?

Final Thoughts

Your ACL rehab is not a race to the finish line; it’s a timely process of restoring strength, flexibility, stability, and power to prove that your body and brain are prepared for your sport again.

What Can Drive Performance Therapy Provide for Your Return to Sport:

✅ Identify your exact strength deficits 

✅ Learn what “ready” really means for your sport 

✅ Leave with a step-by-step roadmap to return stronger — not just healed

You’ve worked too hard to just get “cleared.” It’s time to get ready.

Book your free ACL Performance Call today and get a personalized plan to bridge the gap between rehab and real competition. 

Spots are limited each week because we keep these calls 1-on-1.

👉 Click below to book your free call and take the next step toward your comeback.

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