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Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group
Open accessAbstract
Background: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design: Consensus statement. Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results: Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
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Clinicians use objective factors such as age, time from injury, and strength symmetry in clinical decision-making for return to sport after ACLR; however, these alone do not fully explain why some athletes do not return to sport despite achieving adequate physical rehabilitation.
“Clinicians use objective factors such as age, time from injury, and strength symmetry in clinical decision-making for return to sport after ACLR5–11; however, these alone do not fully explain why some athletes do not return to sport despite achieving adequate physical rehabilitation.12–15”
From Determinants of Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction (2026) · cites this paper as [9]
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Shared decision making: A model for clinical practice
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., et al. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2077-6 · Cited by 4,405 · cited 1×
“The principles of shared decisionmaking apply, and the patient is actively involved.(25,64) A multidisciplinary decision must be made with reasonable compromise from all groups if dissent exists.”
BackgroundMental health in elite athletes: International Olympic Committee consensus statement (2019)
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., et al. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100715 · Cited by 1,277
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Murphy, T., Lyons, L., Mertz-Bynum, N., Lugin, A., Harkey, M. S., Kuenze, C., Baez, S., Myer, G. D., Diekfuss, J., & Petushek, E. (2026) · Journal of Athletic Training · doi:10.4085/1062-6050-0696.25
Metadata
- Authors
- Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., the Panther Symposium ACL Injury Return to Sport Consensus Group, Bizzini, M., Chen, S., Cohen, M., Villa, S. D., Engebretsen, L., Feng, H., Ferretti, M., Fu, F. H., Imhoff, A. B., Kaeding, C. C., Karlsson, J., Kuroda, R., Lynch, A. D., Menetrey, J., Musahl, V., Navarro, R. A., Rabuck, S. J., Siebold, R., Snyder-Mackler, L., Spalding, T., van Eck, C., Vyas, D., Webster, K., & Wilk, K.
- Affiliations
- University of Pittsburgh Medical Center (US)
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Corresponding author
- Meredith, Sean J.
- ORCID
- Meredith, Sean J.
- Rauer, Thomas
- Chmielewski, Terese L.
- Fink, Christian
- Diermeier, Theresa
- Rothrauff, Benjamin B.
- Svantesson, Eleonor
- Hewett, Timothy E.
- Sherman, Seth L.
- Lesniak, Bryson P.
- Bizzini, Mario
- Chen, Shiyi
- Engebretsen, Lars
- Feng, Hua
- Fu, Freddie H.
- Imhoff, Andreas B.
- Kaeding, Christopher C.
- Kuroda, Ryosuke
- Lynch, Andrew D.
- Musahl, Volker
- Navarro, Ronald A.
- Rabuck, Stephen J.
- Spalding, Tim
- van Eck, Carola
- Vyas, Dharmesh
- Webster, Kate
- Venue
- Orthopaedic Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2020-06-01
- Volume
- 8
- Issue
- 6
- Pages
- 2325967120930829-2325967120930829
- ISSN
- 2325-9671 (ISSN-L)
- PMC
- PMC7328222
- OpenAlex
- W3038188393
- Cited by
- 103
- References
- 2
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 14 · 2023: 23 · 2022: 12 · 2021: 7 · 2020: 3
- FWCI
- 10.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Orthopaedic Journal of Sports Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (acceptedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- anterior cruciate ligament injury, return to sport, return to performance, return to sport testing, psychological readiness, functional assessment, associated injuries, multidisciplinary decision-making
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