Football (soccer) is the most popular sport worldwide, with an estimated 300 million active players (as documented by the Fédération Internationale de Football Association).

Anterior cruciate ligament (ACL) injury is one of the most serious injuries in soccer and a potentially career-ending one.

The incidence of ACL injuries in soccer players accounts for thousands of ACL tears per year.

1 Despite the high number of injuries and related literature, there is still no consensus on the optimal surgical technique for ACL reconstruction and even less agreement on the ideal rehabilitation protocol following surgery.

Recently, van Grinsven et al proposed an optimal evidence-based rehabilitation program.

Their systematic review indicated that interventions for the early rehabilitation phases, which included pain/swelling control, neuromuscular training, and early weight-bearing, range-of-motion, and strengthening exercises, are supported by evidence.

Criteria for return to sports include “hop tests and strength of the hamstrings and quadriceps at least of 85% compared to the contralateral side” and “when the patient tolerates sport-specific activities.”

 This description, albeit o!ering a minimal standard for the knee, is clearly not detailed enough when dealing with athletes (ie, soccer players) aiming for a return to competitive sports after ACL reconstruction. 

Some authors have described guidelines for return to play after ACL surgery, however, few publications have specifically discussed the return to competitive soccer.

In a recent review, Kvist located articles that presented outcomes after ACL reconstruction and criteria for returning to sports.

In most cases, the decision of when to allow the patient/athlete to return to sport was empirical and time based, ranging from 3 to 12 months postsurgery.

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