“Do As I Say, Not As I Do”: Clinician Return to Run Criteria, First Run Characteristics, and Running Assessment Analysis After Anterior Cruciate Ligament Reconstruction Compared to the Literature—Insights From an International ACL Rehabilitation Conference

OBJECTIVE: To (i) explore clinician practices related to Returning to Running (RTR) decision-making, (ii) define the characteristics of a first run post- Anterior Cruciate Ligament Reconstruction (ACLR), and (iii) examine the use of running assessment during rehabilitation. STUDY DESIGN: Cross-sectional survey study. METHODS: A 71-item online survey was distributed to clinicians attending the 2023 Aspetar International ACL Rehabilitation Conference. The survey covered patient reported outcome measures (PROMs), time post-surgery, clinical, strength and functional criteria. Responses were compared to current recommendations in the literature. In addition, characteristics of a first run and the use of running assessment and the variables measured were collected. RESULTS: One hundred seventy-seven clinicians from 51 countries completed the survey. Many aligned with core clinical criteria (e.g., full extension, minimal effusion); 64 clinicians (36%) did not use PROMs. Twenty-eight clinicians (16% of 177) used the International Knee Documentation Committee (IKDC) Subjective Knee Form. Most favored strength thresholds ≥80% LSI. Time post-surgery of 12 –14 weeks was selected by 51 clinicians (29%); 44 (25%) did not use a timeline as a criterion. The first run was typically described as a dynamic run lasting 5–10 minutes or covering 500–1000 m, reflecting the most selected responses across clinicians, at self-selected or controlled speeds of 8–10 km/h. Interval running was used by 90 clinicians (51%) for a first run. Running assessment was used by 102 clinicians (58%) during rehabilitation. Six clinicians (3%) collected kinetic data despite knee extension moments (KEM) being the most common deficit reported in literature. CONCLUSION: We found heterogeneity of compliance among ACL clinicians with RTR recommendations in the literature. Although over 50% of clinicians reported using running assessment, less than 5% used devices capable of measuring kinetics to detect the most reported biomechanical running deficits.