24/06/2026
RESEARCH SPOTLIGHT | End-Stage Rehab Testing After ACL Injury 🧐
Getting back to sport isn’t just about being pain-free or hitting a timeline.
A 2025 review by Mengis et al. examined which return-to-sport tests are the most valid, reliable and practical for estimating reinjury risk following ACL reconstruction. While the review focused on ACL injuries, the principles apply to many lower limb injuries.
So what should end-stage rehab include?
💪 Strength
Strong muscles are essential for protecting the knee during sport.
The review recommends:
⭐️ Quadriceps strength testing using either an 8RM test or handheld dynamometry.
⭐️ A quadriceps strength ratio of approximately 0.7-1.0, meaning the hamstrings should be 70-100% as strong as the quadriceps.
🏃 Functional Performance
Strength alone isn’t enough. Athletes also need to demonstrate they can safely tolerate the demands of sport.
Recommended tests include:
⭐️ Drop jumps
⭐️ Single-leg hop for distance
⭐️ Triple hop for distance
⭐️ Crossover hop for distance
Using both vertical and horizontal movement tests provides a more complete picture of readiness.
🧠 Psychological Readiness
Returning to sport also means being mentally prepared.
Validated questionnaires such as:
⭐️ ACL Return to Sport Index (ACL-RSI)
⭐️ Knee Injury and Osteoarthritis Outcome Score (KOOS)
⭐️ Tampa Scale of Kinesiophobia
can help identify confidence levels and fear of reinjury, both of which influence return-to-sport success.
Key takeaway 👇
End-stage rehab testing is critical for determining whether you are fit to return to sport at your desired level and with a reduced risk of injury. A range of physical and psychological factors, including strength, functional ability and fear of movement, should be considered
📖 Reference
Mengis N, Höher J, Ellermann A, et al. (2025). A Guideline for Validated Return-to-Sport Testing in Everyday Clinical Practice: A Focused Review on the Validity, Reliability, and Feasibility of Tests Estimating the Risk of Reinjury After ACL Reconstruction. Orthopaedic Journal of Sports Medicine..
Read more on our blog https://restorefunction.com.au/2026/04/03/are-you-ready-to-return-to-sport/