ACL Series: Case Study and Results

The subject of this case study is a 15 year old high school female soccer player who had just suffered her second ACL tear in a eight month period. Her first injury, in October of 2010, was to the right ACL and her second injury, in June of 2011, was to the left ACL. Her family has a history of ACL tears, as her sister suffered two (one to each knee) and her mother has had two ACL tears as well, which may lead some to believe that this injury may stem from a genetic or anatomical factor.

Four months after rehabilitating her first ACL, the subject entered into the Return to Confidence program to begin the return to sport process. At six months she was cleared by her physical therapist to return to practice with her team, and discontinued her training in our program. At this stage she was making progress, but her fitness and agility were still not up to standard, but her return to sport tests of strength were at passing levels, so her physical therapist cleared her to return to play. In the third game of the state tournament, another player contacted her as she was turning with the ball and she consequently tore her left ACL.

The subject underwent surgery a few weeks later, and started a physical therapy program a few days after surgery. Three weeks into her rehabilitation process, her surgeon and therapist agreed to have her also train in the AthleteFIT Return to Confidence Program to continue to focus on fitness and the non-involved side as she could tolerate.


The program consisted of four days per week of training sessions lasting between thirty and sixty minutes per day. The program was set up in four week blocks that ran parallel to the twenty, orthopedic surgeon protocols for ACL rehab that we reviewed, combined with the exercises and progressions for this population. For a detailed overview of this program, you can download our ACL Return to Confidence eBook.


At the time of her injury, we were testing other soccer players in the same age group in a game speed assessment of sport specific athleticism. The results are shown below. Over the course of the season we trained 4 days a week (1-Fitness, 2-Practice/Strength/Fitness, 3-Practice, 4-Practice/Strength/Fitness).

During this time, the subject of our case study was also training 4 days a week (1-Trianing, 2-Rehab, 3-Training, 4-Conditioning) in our Return to Confidence Program. We did not have a pretest on the subject in our Game Speed Assessment, as she was just coming out of surgery on the date of the initial test, but as you can see by her graph below, she returned to her team with a fitness level well above average in all areas.

Also, notice the balance of the graph. The subject of this case study showed an above average balance between Technical Skill, Speed/Quickness and Soccer Fitness. The weakest area of her game still lies in the speed and quickness aspects but she is still well above the average for her age group, and this category will only improve as she takes the field and begins to train in a faster, more competitive environment.

Subject’s Scores (after Return to Confidence Program):

If we expand our view of this testing process and compare the subject to all age groups (high school girls), you will notice that the quickness component is just a little below what the average player is scoring, but all other areas are well above average and in many cases she challenged the best scores in the high school populations.

We performed a Hop and Stop test at 16 weeks post op and compared it to a similar test that the subject had performed as she was cleared to return to sport after her first ACL tear in November or 2010 where she did not train in the Return to Confidence program until after physical therapy (16 weeks after surgery). As you can see from the results in the table below, her return to sport scores from the first test gave her a symmetry value of 6, which is as good as or better than the average high school girl. She was cleared to play in April of 2011 and tore her other ACL in late June.

After 4 months of training in the Return to Confidence program after her second surgery in July of 2011, we tested her and found her symmetry scores to be almost perfect (a score of 0 would represent a player that is perfectly symmetrical). Her hop scores as a percentage of her height were better than before (better force production) and her leap scores were better as well (better force absorption).

At 5 months after surgery, the player had returned to full contact soccer and reported feeling “confident and fast.”