APKASS 2024 consensus statement on anterior cruciate ligament reconstruction, part Ⅲ: Return to play after anterior cruciate ligament reconstruction

Abstract

Objective: To establish a standardized set of criteria for Return to Play (RTP) after Anterior Cruciate Ligament (ACL) reconstruction based on a consensus among international experts. Methods: An international group of ACL experts convened at the APKASS 2024 Consensus Meeting to address the variability in RTP criteria. Using a structured questionnaire, the experts evaluated six key areas: clinical assessment, functional testing, psychological factors, rehabilitation and reinjury prevention, surgery-related factors, and stakeholder insights. Data were analyzed using a predefined consensus threshold of 75% agreement. Results: The consensus identified several key recommendations for RTP, emphasizing the avoidance of purely time-based decision-making in favour of a more comprehensive approach that incorporates functional and psychological assessments, and sport-specific demands. Notable findings included the endorsement of manual stability tests (Lachman and Pivot Shift) as important components of evaluating knee stability, the critical role of psychological readiness, and the importance of a multifaceted approach involving various stakeholders in the RTP decision-making process. Conclusion: The APKASS 2024 Consensus Statement provides a comprehensive, expert consensus-based framework for RTP after ACL reconstruction and may help promote greater consistency in clinical practice. It highlights the need for a personalized approach that considers the unique recovery progress of athletes. Future research is encouraged to refine RTP protocols further and explore the integration of novel diagnostic and therapeutic technologies. Level of evidence: V (Expert opinion).