Athletes who did not meet the discharge criteria before returning to professional sport had a four times greater risk of sustaining an ACL graft rupture compared with those who met all six RTS criteria. In addition, hamstring to quadriceps strength ratio deficits were associated with an increased risk of an ACL graft rupture.

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Anterior cruciate ligament reconstruction in athletes is carried out to achieve a stable knee that can enable them to return to their desired activities. Unfortunately, today a successful return to sport cannot be guaranteed, and the criteria to return to sport are poorly investigated and poorly described. The purpose of this chapter is to describe the criteria used in Aspetar, based on the existing literature and the long experience of ACL treatments in Aspetar. Therefore, it is the aim of this chapter to deliver a very practical article which can be used by physiotherapists as a guideline in the enigmatic area of return to sport after an ACL reconstruction. The article describes the different phases of the rehabilitation, starting from the running progression program, going to the on-field functional training, and ending by the on-field sports-specific training before returning to team training. Each of these phases is clearly described and objective tests are given to progress from one phase to the other.

Objectives: To determine the test-retest reliability of the submaximal version of the Yo-Yo Intermittent Recovery Test-Level 1 (Yo-Yo IR1-sub), which is a valid aerobic assessment. Design: Test-re-test. Methods: Elite youth soccer players (n = 10, age: 18.8 ± 0.5 years, height: 181.1 ± 4.9 cm, body mass: 74.2 ± 7.6 Kg) completed the Yo-Yo IR1-sub on two consecutive weeks to determine the reliability of a non-exhaustive alternative to maximal aerobic testing. Relative and absolute reliability of the Yo-Yo IR1-sub was assessed for heart rate response and recovery metrics (HR6, HR30, HR60, HR90, HR120, HRR30, HRR60, HRR90 and HRR120). Results: The Yo-Yo IR1-sub was determined to be a reliable alternative to maximal testing, with the final heart rate at the end of the 6 minute test (HR6) shown to be the most reliable metric (ICC = 0.96; SDD = 5.4 bpm). The percentage of heart rate recovered after 2 min (HRR120) was the most reliable recovery metric (ICC = 0.93; SDD = 4.6%). Conclusion: If maximal testing is not a feasible option, particularly during the competitive season or during the rehabilitation of an injured player, then a submaximal test is a reliable alternative to monitor fitness in elite young soccer players, with HR6 and HRR120 being the most stable parameters. (Journal of Trainology 2017;6:31-34)