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Nine months ago, I had an ACL repair of my left knee. Despite the tests that show my strength is good enough to return to jumping, twisting, and pivoting, I just don't feel confident that my knee will hold up. How do I get past this problem?

First of all, don't think you are alone. According to a recent study from Australia, many athletes have a disconnect between what the tests show and what they can actually do on the field or court. The question immediately arises about the athlete. Is he or she holding back because of fear of reinjury? Lack of self-confidence? Is it just a psychologic problem or is there some intuitive knowledge the body is relaying to the mind that the knee just isn't ready for that level of activity? We don't know yet -- maybe a little bit of both, maybe not. Perhaps it has more to do with the test measures. It's possible that the current testing used really doesn't tell the whole story. Many patients seem to have good joint motion, strength, and apparent stability. Commonly used tests such as the Cincinnati Sports Activity Scale (SAS) and the International Knee Documentation Committee (IKDC) evaluation don't seem to correlate well with the actual return-to-sport rate. In other words, the athletes' test scores show normal or nearly normal knee strength, motion, and strength. Yet the athletes' ability to perform essential skills for their sport is poor or non-existent. Some studies using a simple hop test as a measure of readiness for return-to-play indicate that this single test may be a better predictor than the main tests used. This is an area where more investigation and study are needed.

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