Functional Testing is Crucial After an ACL Surgery

If your young athlete has had anterior cruciate ligament (ACL) reconstruction surgery, you know how long and grueling the recovery process can be. Children and teens who have had to sit on the sidelines while healing are often eager to get back to their sport, but it’s critical that these athletes don’t return too soon.

Children’s Healthcare of Atlanta Sports Physical Therapy Manager Julie Johnson explains, “Nearly one in four young athletes who sustain an ACL injury and return to high-risk sports will sustain a secondary ACL injury, most often in the first three months after return to play. It’s clear that improved rehabilitation and more specific return-to-play guidelines for our young athletes will help reduce the risk of secondary injury.”

The experts at the Children’s Sports Medicine Program are committed to minimizing the chance of another injury, which is why they use functional testing.

What is functional testing?

Our sports physical therapists recommend that all young athletes who have ACL reconstruction surgery undergo formal functional testing to determine return to sport readiness. This testing is completed by a sports physical therapist and includes:

  • Knee range of motion assessment
  • Measurement of the amount of muscle development in the upper thigh
  • Strength assessment using a hand-held dynamometer to provide peak force measurements
  • Functional balance assessment
  • Functional hop testing assessment
  • Subjective psychological scoring to determine confidence levels in performing sport activities

After the testing is complete, athletes  receive a Functional Testing Report to bring to their surgeon at their 6-month post-operative appointment. Their Children’s sports physical therapist will make a recommendation on readiness for return to sport based on patient performance in relation to risk for re-injury.

“By providing this information to orthopedic surgeons, we’re helping to guide them in their decision on return-to-sport readiness based on functional performance—and who better to give this information than experts in functional assessment?” says Julie.

Using data to make informed decisions

This unique testing empowers physicians with valuable data—that most programs don’t have—before they allow a patient to return to sport. S. Clifton Willimon, MD,  Medical Director of Orthopedics Quality and Outcomes at Children's, says “Many times, doctors allow kids to return to play based only on the amount of time that’s passed since surgery instead of considering factors like strength, balance and proper form during sport-specific movements, like jumping and landing.” Children’s is actively reviewing outcomes and exploring research opportunities with functional testing to help young athletes recover and prevent future injuries.

“Our hope is that together we can make informed decisions based on evidence in research that will help decrease the risk of re-injury for our young athletes,” Julie says. It’s just another reason it’s critical for growing bodies to have specialized care that’s 100 percent dedicated to kids.

Visit to make an appointment with a sports physical therapist at Children’s.

Julie Johnson is a board-certified specialist in sports physical therapy, a certified strength and conditioning specialist, and manager of Children’s Sports Physical Therapy. She is also the Children’s Sports Residency Program Director. Julie has a professional interest in the rehabilitation of athletes after ACL reconstruction and is actively involved in the development of the Children’s postoperative ACL return to sport guidelines and functional testing.

Dr. Willimon is a board-certified orthopedic surgeon, Medical Director of the Atlanta United FC Academy, as well the Medical Director for Children’s Orthopedic Quality and Outcomes. He specializes in disorders of the knee, hip, shoulder and elbow. He practices advanced arthroscopic and reconstructive surgical techniques for the treatment of complex disorders of the hip, knee, shoulder and elbow as well as all sports-related injuries.