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

OBJECTIVES: To (1) explore clinician practices related to return-to-running (RTR) decision making, (2) define the characteristics of a first run after anterior cruciate ligament (ACL) reconstruction, and (3) examine the use of running assessment during rehabilitation. DESIGN: Cross-sectional survey study. METHODS: A 71-item online survey was distributed to clinicians who were attending the 2023 Aspetar International ACL Rehabilitation Conference. The survey covered patient-reported outcome measures (PROMs); time postsurgery; and clinical, strength, and functional criteria. Responses were compared to current recommendations from the literature. Data on the characteristics of a first run and the use of running assessment and variables measured were also collected. RESULTS: One hundred seventy-seven clinicians from 51 countries completed the survey. Of the 177 clinicians, many aligned with core clinical criteria (eg, full extension, minimal effusion), 64 (36%) did not use PROMs, 28 (16%) used the International Knee Documentation Committee Subjective Knee Form, most favored strength thresholds ≥80% limb symmetry index, 51 (29%) selected time postsurgery of 12-14 weeks, and 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 being the most common deficit reported in the 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. JOSPT Open 2026;4(3):328-339. Epub 9 April 2026. doi:10.2519/josptopen.2026.0195.