Athletes can return to sports successfully after ACLR even though there are chances of re-injury. Rehabilitation process has been shortened and they may return as soon as 4 months post-operatively. However, it is unclear that what is healthy and what is unhealthy to do in a rehabilitation process. We do know what puts stress on the graft and mechanisms of injury. So, we need to avoid things that stress it. For example, during the last 30 degrees of open kinetic knee extension, ACL is under stress from quadriceps muscle contraction force. But we can only assume that things such as walking, weight-bearing, not using a knee brace or crutches are safe to do. But we do not know for sure that it is safe in a long run. We just know that athletes do well either way and it does not appear to affect rehabilitation process or re-injury rate. It is difficult to know how safe and what is safe without knowing graft maturation process and when they are ready to do what. To our knowledge, there are no studies that show when it is too early to do what in terms of graft safety and re-injury rate. We just know the most athletes do well with current ACLR rehabilitation protocols. We feel like there are a lot more studies to be done on this topic especially some studies suggest that ACL grafts elongate after surgery as much as 3mm compared to graft length at the time of reconstruction. Some studies show that re-injury rate after ACLR in active people may be up to 18%. There are many things we know about ACL compared to 10 years ago, but, at the same time, there are many things we do not know yet.
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