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Return to Sports After ACL Surgery: Is There a Difference Between Boys and Girls?

Myth or Fact: Women take longer to heal and return to sports after knee (ACL) surgery later when compared with men.
Myth or Fact: No one should go back to full-activity or sports for at least six months after ACL surgery.
Myth or Fact: If you've had one ACL injury, you're likely to have another knee injury.

Athletes of all ages involved in competitive sports have heard these statements as facts. But are they really? The authors of this article share their knowledge and experience after doing almost 3,000 anterior cruciate ligament (ACL) reconstructive surgeries.

Out of those 3,000 cases, 413 were middle school or high school athletes involved in basketball or soccer. Only athletes (male and female) 17 and younger were included in this study. Many played year-round on school and other travel teams.

The authors intend to follow these patients long-term and eventually report on a variety of results. Data collected included age, sex, and sport(s) played (before and after surgery). Everyone filled out a survey rating their function and activity level.

They watched to see how long it took the athletes to return to full activity, including team competition. No one was pushed to return to sports before they were ready. And they kept track of how many patients went on to play college sports. After the first year post-op, everyone was followed on an annual (yearly) basis. Any injuries to the other (previously uninvolved) knee were reported.

The players were given goals for rehab and guidelines for progressing through the program. The first goal was to reduce swelling and get full knee motion back. Once they had full range-of-motion, then they could be advanced to a strengthening program. Because basketball and soccer require fast moves, change of direction, pivoting and twisting, agility drills were added to the rehab program. When they were ready, recovering players were progressed to team drills and functional sports drills.

Players were told to pursue the rehab program as tolerated. They were instructed to monitor their own knee range-of-motion, swelling, soreness, pain, and tenderness. Any increase in symptoms or loss of motion was a sign that they should back off from their program and take it easy for a day. In the beginning sports drills and competition were limited to every other day.

Here's what they found. First myth: Was there a difference between boys and girls in terms of healing and return to sports? No. An equal percentage of players returned to competitive sports after surgery regardless of gender.

Second myth: Was it necessary to wait six months before getting back into action? No. Many players completed the rehab program and returned to their former level of play as early as three months after surgery. And they did so without incurring future injuries (third myth). The average time for recovery was five months.

Some other studies do show a difference in results based on gender. But the authors suggest that age may have been a determining factor. Whereas the age of their patients was 17 and younger, the results of other studies are reported for adults. One other difference may be the way rehab was progressed in this study (as tolerated). Letting the athletes regulate their own pace (instead of pushing them too far, too fast) may be an important factor in a successful rehab program.

The authors conclude that boys and girls engaged in middle school or high school soccer or basketball return to their preinjury level of sports activities equally. A quick return to full sports after ACL reconstruction surgery is not a factor for early reinjury.

Athletes should be allowed to resume activities when they feel comfortable. Mild swelling and soreness may occur after activity and sports training. Knowing how to manage this and gauge subsequent activity is an important part of the recovery process.


K. Donald Shelbourne, MD, et al. Return to Basketball and Soccer After Anterior Cruciate Ligament Reconstruction in Competitive School-Aged Athletes. In Sports Health. May/June 2009. Vol. 1. No. 3. Pp. 236-241.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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