February 19, 2025

How to Reduce Your Risk of Re-Injury After an ACL Tear

Author
Henry Davies
Avoiding the Nightmare of a Second ACL Injury

Rehabbing from an ACL tear is a long, gruelling process. But the real challenge comes when you try to return to your sport. The risk of re-injury is real. Studies show that 30% of athletes who return to high-level sports suffer another knee injury within two years. If you don’t take the right steps, you could risk re-injury.

Facing another year of rehab, frustration, and lost progress.

The good news? There are proven ways to reduce your risk of re-injury and return to play. Following the right approach can build strength. And restore balance, protecting your knee for the long term.
Many athletes rush the process. Returning too soon and without meeting key recovery milestones. This puts them at serious risk.




Why So Many Athletes Re-injure Their ACL

Many athletes fail to stay injury-free because they make one (or more) of these common mistakes:
  • Returning to sport too soon – Research shows that returning before nine months post-surgery increases the risk of reinjury by over 50% per month.
  • Neglecting quadriceps strength – Asymmetrical quad strength leads to poor knee control and higher injury risk.
  • Skipping functional testing – Many athletes return to play without passing key tests like hop tests and strength symmetry assessments.
  • Ignoring movement mechanics – Poor landing, cutting, and pivoting mechanics increase the risk of ACL failure.
  • Lack of sport-specific preparation – Going straight from rehab exercises to full gameplay is a recipe for disaster.
If you avoid these mistakes, you’ll give yourself the best chance of staying injury-free and performing at your best. Here’s how to do it:

Step 1: Delay Your Return Until At Least Nine Months Post-Surgery

What is the biggest mistake athletes make? Coming back too soon. Studies show that delaying your return to high-impact sports until at least nine months after surgery can cut your risk of reinjury in half. 
Think of your ACL like a healing wound. If you remove the stitches too early, the wound reopens. Your knee needs time to fully heal, regain strength, and restore neuromuscular control before facing the demands of sport. 

Actionable Tip: Work closely with your rehab team to track progress and ensure your knee is ready. Don’t just go by time—use objective markers like strength tests, balance tests, and movement assessments.

Step 2:Build Symmetrical Quad Strength

Many athletes return to sport with one leg significantly weaker than the other. This strength imbalance puts more stress on the reconstructed ACL, increasing the risk of re-injury. In fact, every 1% improvement in quad symmetry reduces injury risk by 3%.

How to Fix It:
  • Use isokinetic testing (if available) or simple single leg exercises to measure strength differences.
  • Prioritize single-leg strength work (split squats, step-ups, single-leg press).
  • Continue progressive resistance training even after returning to sport. Strength fades fast if neglected.

Step 3: Pass Functional Return to Sport Tests

You wouldn’t drive a car without checking the brakes—so why return to sport without testing your knee? Athletes who pass a Return to Sport (RTS) test are significantly less likely to re-injure their knee. 

Your rehab should include:
  • Rate of force development testing: Single leg squat jump and countermovement jump
  • Hop Tests: Single leg hop, triple hop, crossover hop, and timed hop to assess explosive power and stability.
  • Landing Mechanics Training: Focus on proper knee alignment when jumping and cutting.
  • Agility and Sport-Specific Drills: Replicate gamelike movements before returning to full competition.

Actionable Tip: Before stepping back onto the pitch or court, work with a rehab professional to complete a full return to sport assessment. If you don’t pass, you’re not ready!

Take Action Now to Protect Your Knee
Recovering from an ACL tear is tough, but returning stronger and staying injury free is the real victory. By following these steps you give yourself the best shot at a long, healthy career in sport.


Reference: Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M.A. (2016). Simple decision rules reduce reinjury risk after anterior cruciate ligament reconstruction: The Delaware-Oslo ACL Cohort Study. British Journal of Sports Medicine, 50(13), pp. 804–808. doi:10.1136/bjsports-2016-096031.

 
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AUTHOR

Henry Davies

Henry is the founder of Integrate Sports. He is a UKSCA accredited practitioner with over 10 years’ experience working with high performing athletes. He has worked with Olympic medallists and prepared athletes for Tokyo 2020 in his role with the English Institute of Sport. Henry is a Lecturer in Strength and Conditioning at Hartpury University, and the Head of Strength and Conditioning at Hockey Wales.
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