12 months post-op, athletes are still rocking a 20-30% quad deficit. Even worse? That "healthy" limb we use as a benchmark? It’s actually getting weaker over time. When your "good" leg loses steam, your surgical leg looks better on paper without actually gaining an ounce of power.
We aren't seeing true recovery; we're seeing bilateral decline.
If you aren't measuring absolute strength and addressing graft-site morbidity, you're guessing, not assessing. It’s time to move beyond simple ratios and start looking at the real numbers.
Stop settling for "symmetrical" weakness.
A Deep Dive into the 2025 BJSM Meta-Analysis
A massive longitudinal multivariate meta-analysis investigating quad/hamstring recovery from pre-surgery to 5+ years post-ACLR, examining the influence of graft type, age, and time.
The uninjured limb decreases in strength over time. Relying on Limb Symmetry Index (LSI) creates a false benchmark.
Massive gap persisting 12 months post-op.
Recovery stalls early without targeted loading.
Uninjured limbs are not stable controls. Move toward absolute strength goals (Nm/kg) to ensure true athletic readiness.