Reporting Return-to-Sport Criteria After Anterior Cruciate Ligament Reconstruction Using StaRI: A Single-Site Retrospective Proof-of-Concept Study

BackgroundMore than half of athletes return to sport after anterior cruciate ligament (ACL) reconstruction without meeting return-to-sport (RTS) criteria, contributing to reinjury rates approaching 25%.While extensive literature recommends individual RTS assessment components, few studies document real-world implementation or provide systematic reporting frameworks for clinical protocols. PurposeThe aim of this study was to demonstrate a systematic approach for reporting implemented RTS criteria using implementation reporting standards, providing healthcare systems a replicable framework for protocol review. MethodsA retrospective observational study, utilizing the Standards for Reporting Implementation Studies (StaRI), analyzed de-identified electronic medical records from a single sport-specific rehabilitation clinic over a three-year period.Nineteen patient records met the following inclusion criteria: referral after ACL reconstruction, passing of comprehensive RTS criteria, and affiliation with a healthcare system sporting partner.The implemented protocol assessed anthropometric measures, movement screens, strength testing, gait analysis, jump performance, and psychological readiness.The prevalence of subsequent lower extremity injury at one-year follow-up was collected via practitioner phone contact. ResultsPatients achieved RTS clearance at 263 ± 85 days (8.7 ± 2.8 months) post-surgery.The mean age was 17.9 ± 1.7 years, with 5 patients returning to collegiate athletics and 14 to high school athletics.At the one-year follow-up, subsequent injury prevalence was 10.5% (one contralateral ACL rupture, one ipsilateral meniscus injury). DiscussionThis proof-of-concept study demonstrates that comprehensive RTS criteria can be reported using StaRI, describing both the criteria and the clinical context in which they were delivered.While heterogeneity in RTS protocols will persist because of varying resources and populations, standardized reporting methodologies can provide healthcare systems with a replicable model for assessing protocol implementation and informing expansion decisions.Future prospective multi-site studies assessing RTS criteria using frameworks such as RE-AIM may elevate clinical practice and transform ACL rehabilitation toward feasible, evidence-informed care.