Existing return to play (RTP) assessments have not demonstrated the ability to decrease risk of subsequent anterior cruciate ligament (ACL) injury after reconstruction (ACLR). RTP criteria are standardized and do not simulate the physical and cognitive activity required by the practice of sport. Most RTP criteria do not include an ecological approach. There are scientific algorithms as the “5 factor maximum model” that can identify risk profiles and help reduce the risk of a second anterior cruciate ligament injury. Nevertheless, these algorithms remain too standardized and do not include the situations experienced in games by soccer players. This is why it is important to integrate ecological situations specific to the environment of soccer players in order to evaluate players under conditions closest to their sporting activity, especially with high cognitive load. One should identify high risk players under two conditions: Clinical analyses commonly include assessments such as isokinetic testing, functional tests (hop tests, vertical force-velocity, profile), running, clinical assessments (range of motion and graft laxity), proprioception and balance (Star Excursion Balance Test modified, Y-Balance, stabilometry) and psychological parameters (kinesophobia, quality of life and fear of re-injury). Field testing usually includes game simulation, evaluation under dual-task conditions, fatigue and workload analysis, deceleration, timed-agility-test and horizontal force-velocity profiles. Although it seems important to evaluate strength, psychological variables and aerobic and anaerobic capacities, evaluation of neuromotor control in standard and ecological situations may be helpful for reducing the risk of injury after ACLR. This proposal for RTP testing after ACLR is supported by the scientific literature and attempts to approximate the physical and cognitive loads during a soccer match. Future scientific investigation will be required to demonstrate the validity of this approach. Level of Evidence 5

Background: For years, the rupture of the anterior cruciate ligament (ACL) has been a feared injury in young soccer players since it causes physiological and psychological changes while incurring significant economic losses. Methods: Through clinical research, understanding the mechanisms and identifying risk factors has enabled sports and performance professionals to establish robust models to predict and reduce the risk of ACL injury. Developments in medical devices also allow a more precise, more objective assessment and improve the traceability of the various quantitative and qualitative parameters necessary to detect the risk of ACL injury. Results: While general preventive protocols have shown evidence for an overall reduction in injury, there are still limitations regarding ACL injury. Therefore, we can collect personalized data from these models and the variables involved, predict, prevent, and program performance throughout the season. Additionally, the multi-professional team supervising the athlete must establish a close relationship centered on feeling and listening to the player who remains in control of his performance. Conclusion: Let the players decide on their career and not an injury.

Background:The anterior cruciate ligament (ACL) tear is the most common sports injury. Surgery is often proposed, but single-leg and double-leg static postural disorders have been discovered several months after surgery. Our aims are to compare postural disorders after ligament reconstruction by hamstring tendon graft in the three months after surgery to those caused by aging. Methods: 2 groups of subjects underwent bilateral and unilateral postural tests. An analysis of the center of pressure's displacement is carried out for each test. Results: Comparison of the two groups shows no significant difference for the injured leg on the unilateral and bilateral tests only (p-value>0,05). Conclusion:Postural alteration after an ACL reconstruction on the injured leg and bilateral posture can be compared to postural disorders caused by age.

Anterior Cruciate Ligament (ACL) tear is currently a main issue in all of sports communities. Although the number of ACL injuries in football remains low, it’s consequences on both professional and personal lives remain a major concern of rehabilitation. If practitioners often require more time to bring athletes in the best condition, the fact remains that this concept of time before return to sport is nowadays considered as obsolete. Indeed, the better understanding of the mechanisms of lesion and the strains placed on the graft after reconstruction, allow us to establish a personalized program based on clinical criteria and the patient's objectives. The current scientific literature allows us today to optimize the return to play and performance by the use of neuromotor and neurocognitive approaches, muscle strengthening methods and a preventive program necessary to cover the previous level of the players while taking into account physiological and psychological changes due to ACL reconstruction. Indeed, it is important to have a systemic approach centered on the patient, the sports movement, as close as possible to the field in order to find an optimal function of the knee in interaction with its environment.If there is a risk of reinjury of the ACL, it appears important to be able to identify the risk factors so that the player can return to play in optimal conditions.

Background: Rehabilitation following an anterior cruciate ligament reconstruction (ACLR) will allow the patient to regain his functional capacities and support him in the resumption of sports activity. Rehabilitation also aims to minimize the recurrence risk, ensuring the good development of the patient's muscular capacities until returning to sport. Isokinetism allows the strengthening and evaluation of this muscular strength of the thigh muscle groups. Still, controversy exists about its use by resistance to knee extension in the open kinetic chain, which would cause the graft's distension. This study aims to determine the influence of muscle strengthening of the quadriceps in the open kinetic chain by using isokinetism on the possible laxity of the anterior cruciate ligament and being able to develop risk factors for it. Methods:The study is based on a population having benefited from an ACLR with a hamstring graft six months postoperatively. Two groups are differentiated; one group exposed to isokinetic during their rehabilitation, the other group, undergoing rehabilitation without the use of isokinetism is the unexposed group. An anterior knee laxity test is performed six months postoperatively using the unexposed group. According to the same protocol, the anterior knee laxity test is performed 6 months post-operatively using all subjects' GNRB® machine. The test results underwent statistical analysis to determine the relative risk of plastic surgery for each study group. Results:Comparing each group's results by a univariate analysis did not reveal any significant results. Multivariate analysis to show interactions between the study groups. It was found that the use of isokinetism would seem not to affect the risk of developing distension for the majority of subjects in the exposed group. A tendency towards protection was found for exposed subjects aged between 25 and 35 regarding the graft's distension. Also, a tendency to protection was found in the exposed subjects regarding an alteration of the graft leading to an anatomically comparable difference. Conclusion:The use of isokinetism does not seem to cause distension of the graft in patients operated on ACLR when this method is introduced three months postoperatively.