What are my chances of tearing my ACL again?

The honest answer depends on your individual risk profile, but the population-level data is sobering. Across active populations, the overall risk of a second ACL tear to either knee is 15-25%. For patients under 25 returning to high-demand pivoting sport, that combined risk rises to approximately 23% - nearly 1 in 4. For professional footballers returning to elite competition, second injury rates in some series reach 17-42% depending on the subgroup. These figures are not quoted to alarm but to make clear why the rehabilitation criteria for return to sport exist. The 84% risk reduction achievable through evidence-based decision rules (Grindem et al., BJSM, 2016) demonstrates that these are not fixed outcomes - they are outcomes of inadequate preparation that proper rehabilitation can substantially change.

Can I tear my other knee (contralateral) after ACL reconstruction?

Yes - and the risk is higher than most patients realise. Contralateral ACL tears are more common than ipsilateral graft ruptures at longer follow-up, with rates of 8-15% reported across the literature. For female athletes, the contralateral risk is particularly elevated - 22.5% versus 8.7% in males in the most recent systematic review (Gao et al., 2023). The mechanism reflects compensatory movement patterns developed during rehabilitation, where the reconstructed side is protected and the opposite knee carries excess load - combined with the biomechanical risk factors that contributed to the first injury remaining unresolved. A rehabilitation programme that addresses landing mechanics bilaterally, restores hip and core control on both sides, and includes the non-operated knee in the strengthening programme reduces this risk directly.

Why does returning to sport early increase my reinjury risk so dramatically?

There are three distinct mechanisms. First, graft ligamentisation - the biological process by which the transplanted graft remodels into functional ligament tissue - takes a minimum of 12-18 months to complete and cannot be accelerated by exercise. During this period the graft is mechanically weaker than the mature tissue it will eventually become, and premature return exposes it to loads it cannot adequately resist. Second, quadriceps and hamstring strength deficits at the time of early return mean that the neuromuscular protection that should reduce joint loading under dynamic sport conditions is absent. Third, neurocognitive readiness - the capacity to react appropriately to unpredictable situations - is frequently incomplete at early return, leaving the graft vulnerable when the environment becomes chaotic.

I passed all my tests. Am I safe to return to sport?

Passing a testing battery substantially reduces your reinjury risk - but does not eliminate it. The Kotsifaki et al. (2025) Aspetar data showed that meeting discharge criteria was the single most important factor for successful return, associated with a 6-fold increase in return to pivoting sport probability. However, the JOSPT 2019 systematic review by Losciale and colleagues confirmed that passing current return-to-sport criteria does not eliminate reinjury risk entirely - there remain athletes who pass all tests and subsequently sustain a second injury. The most current multi-modal testing batteries - incorporating strength symmetry, hop tests, force plate landing analysis, and ACL-RSI - provide the best available picture of readiness, but no test battery guarantees zero risk. Sport-specific rehabilitation, neurocognitive training, and continued gym work after return are all additional layers of protection.

I had a hamstring graft. Does that increase my reinjury risk?

Yes, modestly, in comparison to patellar tendon autograft - particularly in younger athletes in pivoting sports. The AJSM 2024 registry study by Yang and colleagues, covering nearly 22,000 patients, found a 1.5-fold higher revision risk for hamstring versus patellar tendon autograft. In athletes under 18, the differential is more pronounced. This does not make hamstring autograft a wrong choice - for the right patient profile it remains excellent. But it is one of the reasons that age, sport, and graft type are all considered together in reinjury risk stratification, and why the threshold for meeting criteria before discharge may be higher for hamstring graft patients in high-risk sporting profiles.

What is the ACL-RSI and why does it matter for reinjury risk?

The ACL Return to Sport after Injury (ACL-RSI) scale is a validated patient-reported outcome measure assessing psychological readiness to return to sport after ACL reconstruction. It specifically measures fear of reinjury, confidence in performance, and risk appraisal. Research has consistently demonstrated that ACL-RSI scores below threshold independently predict both failure to return to pre-injury sport level and elevated reinjury risk. This is not simply about confidence - it reflects that psychological unreadiness alters movement patterns in ways that increase mechanical loading on the graft. Equally important: high ACL-RSI scores in patients who are not physically ready can reflect overconfidence that itself elevates risk. Psychological and physical readiness are parallel but not interchangeable.

Can a second ACL injury be prevented completely?

Not completely - but substantially. The Delaware-Oslo rules (Grindem et al., BJSM, 2016) demonstrated an 84% reduction in reinjury risk when three criteria were met together: delaying return until 9 months while completing rehabilitation, achieving 90% quadriceps limb symmetry, and passing functional hop testing. For patients who also add force plate assessment of landing mechanics, ACL-RSI screening, and neurocognitive rehabilitation to that battery, the protective coverage is even more complete. The remaining irreducible risk reflects the inherently unpredictable nature of contact and reactive sport situations. What the evidence makes clear is that the majority of second ACL injuries are not bad luck - they are predictable outcomes of returning before the knee and the athlete are genuinely ready.

a close up of man getting treatment from a physio

ACL Rehabilitation

Football Rehabilitation

Graft Choice

Meniscal Injury Rehabilitation

Gym Rehabilitation

Reinjury Risk

Psychological Recovery

Womens Injury Risk

ACL Rehabilitation Timeline

Return to Performance

Reinjury Risk After ACL Reconstruction: What the Evidence Actually Shows

Q: Does waiting 9 months before returning to sport actually reduce my risk?

The evidence here is now more nuanced than the simple 9-month rule suggests. The Delaware-Oslo cohort study (Grindem et al., 2016) showed that each month of delay to 9 months reduces reinjury risk by approximately 51% - but this was in a population where rehabilitation completion was not a controlled variable. The most recent paper from the Aspetar group (Kotsifaki et al., BJSM, 2025) found that among 530 male athletes who met objective discharge criteria, time to return to sport was not associated with reinjury risk - whether they returned before or after 9 months made no statistically significant difference when criteria were met. The clinical message is criteria before calendar: completing the rehabilitation programme and meeting objective tests is the primary protective factor. The 9-month guideline remains appropriate as a minimum for most patients precisely because most patients have not completed what is required by that point.

The second ACL injury is more common than most patients are told - and more preventable than most rehabilitation programmes reflect

Written by

Andrew Balderston

MSc, HCPC, MCSP, AACP

Clinical Director and COO, Atherapy

FIFA Diploma in Football Medicine
Hull City FC, Head of Medical Services, 2018–2025
Nottingham Forest FC, 2009–2018

Read Andrew's Profile

About the author

Reinjury after ACL reconstruction is not a rare complication - it is a common and predictable outcome for patients who return to demanding sport without meeting objective criteria, without adequate time for graft maturation, and without the neuromuscular control and psychological readiness that safe return requires.

Over twenty years managing ACL injuries in professional football, Andrew Balderston has seen both sides of this: players who returned too early and paid the price, and players who did the work, met the criteria, and went on to have long careers. The evidence on what predicts reinjury is clear and the protective strategies are known. This page explains both in plain terms.

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The question that sits behind every ACL rehabilitation programme - whether patients articulate it or not - is this: will I tear it again? The answer from the research is both more concerning and more empowering than most patients receive from their surgical team. More concerning because the rates of second ACL injury are substantially higher than the 5-10% figure that is sometimes quoted. More empowering because the evidence on what reduces that risk is clear, actionable, and largely under the patient's control.

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This page presents the data honestly. It explains who is at greatest risk, which risk factors are modifiable and which are not, what the research now says about the 9-month timeline debate, and what the specific strategies are that the evidence shows can reduce reinjury risk by up to 84%. Understanding these numbers is not about creating anxiety - it is about making sure that every decision made during rehabilitation is informed by the actual stakes involved.

The Numbers Every ACL Patient Should Know

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The overall risk of sustaining a second ACL tear to either knee after reconstruction ranges between 15% and 25% for active populations. This encompasses two distinct risks that are often conflated: a 6-11% risk of tearing the reconstructed graft on the same side (ipsilateral), and an 8-15% risk of tearing the opposite, previously healthy knee (contralateral). The pooled 2023 systematic review by Gao and colleagues, synthesising 14 competitive athletic studies, confirmed an ipsilateral graft failure rate of 6.2% and a contralateral risk of 8.6%. The 2024 systematic review by Piussi and colleagues (JOSPT) found a pooled second ACL injury incidence of 16.9% across 21 studies, with patients who sustained a second injury having returned to sport a mean of 25 days earlier than those who did not.

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For younger athletes and those returning to high-demand pivoting sports, the risk is substantially higher. The landmark systematic review and meta-analysis by Wiggins and colleagues (AJSM, 2016) - tracking 19 studies covering younger active populations - found that the combined second ACL injury rate for patients under 25 returning to high-demand sport was 23%. Nearly 1 in 4. For the highest-risk subgroups - adolescents under 20 returning to pivoting sport within the first year post-surgery - cumulative reinjury rates approach 30-40% within two years.

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Clinical Note

ACL Reinjury: The Key Numbers

15-25%: overall second ACL injury risk across active populations
6-11%: ipsilateral graft failure rate (the reconstructed knee)
8-15%: contralateral ACL tear rate (the previously healthy knee)
23%: combined reinjury rate in patients under 25 returning to high-demand sport (Wiggins et al., AJSM, 2016)
17.8%: second ACL injury incidence in male professional footballers; 42% in those with non-contact isolated index tear (11 of 26 players) (Della Villa et al., BJSM, 2021)
84%: maximum risk reduction achievable by applying the Delaware-Oslo decision rules (Grindem et al., BJSM, 2016)

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"Nearly 1 in 4 patients under 25 who return to pivoting sport will sustain a second ACL injury. These are not rare events. They are predictable outcomes of inadequate rehabilitation and premature return."

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Ipsilateral vs Contralateral: Two Different Risks

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Understanding that reinjury risk falls into two entirely different categories is clinically important because the protective strategies for each differ. An ipsilateral graft rupture - tearing the reconstructed graft - reflects inadequate structural and neuromuscular recovery of the operated knee. A contralateral ACL tear - injuring the previously healthy opposite knee - reflects the compensatory overloading of a limb that has been carrying excess demand throughout rehabilitation while the reconstructed side was relatively protected.

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Gao and colleagues (OJSM, 2023) found that contralateral tears are actually more common than ipsilateral failures at longer follow-up - Wright and colleagues showed a contralateral rate approximately twice the ipsilateral rate at 5-year follow-up (11.8% vs 5.8%), consistent with Paterno and colleagues' data. The mechanism is well characterised: patients who undergo ACL reconstruction frequently develop compensatory movement strategies that offload the reconstructed limb and overload the contralateral side. This elevated contralateral loading, combined with the original biomechanical risk factors that contributed to the first injury remaining unresolved, places the opposite knee under chronically elevated stress.

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For female athletes, the contralateral risk is disproportionately high. Gao et al. confirmed a contralateral ACL injury rate of 22.5% in females versus 8.7% in males - reflecting the persistence of the biomechanical risk factors (greater knee valgus loading, reduced hip abductor control, altered landing mechanics) that contributed to the initial injury and that ACL reconstruction itself does nothing to address. Reducing contralateral risk requires a rehabilitation programme that specifically targets these factors - not just the reconstructed side.

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Who Is at Highest Risk

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Risk stratification before return to sport is the foundation of safe ACL rehabilitation. Several patient characteristics are well established as independent risk factors for second injury, and knowing which group a patient falls into should directly influence the aggressiveness of the rehabilitation criteria applied before clearance.

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Risk Factor	Quantified Risk	Clinical Source
Age under 25	Combined reinjury rate 23% vs 15% overall; under-20s approaching 1 in 4	Wiggins et al., AJSM, 2016
Return to Level 1 pivoting sport	4-fold increase in reinjury risk vs non-pivoting sport	Grindem et al., BJSM, 2016
Early return (before 9 months)	Each month delay to 9 months reduces risk by 51%; early return = up to 7-fold risk increase	Grindem et al., BJSM, 2016; AOSSM 2025
Criteria not met at discharge	Athletes who met discharge criteria were 6x more likely to successfully return to pivoting sport	Kotsifaki et al., BJSM, 2025
Hamstring autograft (vs BPTB)	1.5x higher revision risk (21,973 patients); HT failure rate 15% vs 9% for BPTB in young athletes	Yang et al., AJSM, 2024
Quadriceps LSI below 90%	More symmetrical quadriceps strength prior to return significantly reduces reinjury rate; LSI below 90% is a well-established independent risk factor	Grindem et al., BJSM, 2016
Female sex in pivoting sports	Contralateral ACL injury rate 22.5% in females vs 8.7% in males; female-specific biomechanical risk factors persist post-reconstruction	Gao et al., OJSM, 2023
Psychological unreadiness / kinesiophobia	ACL-RSI below threshold independently predicts reinjury; both fear of reinjury and low self-efficacy elevate risk independently of physical test results	Ardern et al., BJSM, 2014; Sonesson et al., AJSM, 2021

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The Risk Factors You Can Change

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Of the risk factors listed above, some are fixed - age, sex, sport type, and index injury mechanism cannot be modified. Others are directly addressable through rehabilitation. Understanding which is which is essential for honest patient counselling and for structuring a programme that actually reduces risk.

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Modifiable Risk Factors and What Changes Them

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Quadriceps and hamstring strength deficit: Addressed through progressive gym-based rehabilitation to criteria. More symmetrical quadriceps strength prior to return significantly reduces the knee reinjury rate (Grindem et al., 2016). Target: 90% LSI minimum for return to sport.

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Neuromuscular control and landing mechanics: Addressed through progressive plyometric training, perturbation training, and force plate assessment. Persistent landing asymmetries predict second injury independent of strength symmetry.

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Timing of return: Addressed by delaying clearance until objective criteria are met. Each month of delay up to 9 months reduces risk by 51% in patients who have not yet met criteria. This is not an argument for arbitrary delay - it is an argument for criteria first, calendar second.

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Psychological readiness: Addressed through ACL-RSI assessment and targeted psychological support. Fear of reinjury and overconfidence both elevate risk independently of physical readiness - the two domains are not interchangeable.

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Contralateral limb loading: Addressed by including bilateral assessment in all testing, actively retraining landing mechanics on the contralateral side, and not treating the non-operated knee as irrelevant to the rehabilitation programme.

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Graft choice (for patients pre-operatively): Where reinjury risk is a primary concern - young athletes, pivoting sports, high pivot shift grade - graft selection and the decision about lateral tenodesis augmentation (LET) are modifiable before surgery. See the Graft Choice page.

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The Timing Debate: 9 Months Revisited

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For a decade, the clinical message around ACL return-to-sport timing has been anchored in the Grindem et al. (2016) Delaware-Oslo data: each month of delay up to 9 months reduces reinjury risk by approximately 51%. This has been interpreted by many clinicians as a justification for a universal 9-month minimum - the idea that time itself is a protective factor.

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The most important paper of 2025 in this space challenges that interpretation directly. Kotsifaki, King, Bahr and Whiteley at Aspetar (BJSM, 2025) - prospectively following 530 male athletes in pivoting sports for two years after ACLR - found that among athletes who completed rehabilitation and met objective discharge criteria, time to return to sport was not associated with the risk of new knee or ACL injury. Athletes who met criteria and returned before 9 months did not show higher reinjury rates than those who returned after 9 months. The hazard ratio for new knee injury was 0.892 (p=0.79) and for new ACL injury 0.718 (p=0.56) - neither statistically significant. Critically, athletes who met discharge criteria were 6 times more likely to return to pivoting sport than those who stopped attending rehabilitation.

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The clinical implication is important but requires careful framing. The Kotsifaki et al. (2025) finding does not mean the 9-month guideline is wrong or that early return is safe. It means that for athletes who have genuinely completed rehabilitation and passed objective criteria, the 9-month mark does not carry independent protective value beyond those criteria. The Grindem data - showing 51% monthly risk reduction - was generated in a population where criteria completion was not a controlled variable. The two findings are compatible: time matters because most patients have not completed the rehabilitation required to be genuinely ready, and because graft ligamentisation biology takes time that no exercise programme can fully accelerate. But for a patient who has done the work and passed the tests, the calendar alone is not the barrier.

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"Criteria before calendar. Time matters - but only because most patients have not yet done what is needed. For those who have, the evidence is shifting."

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Clinical Caution

The Kotsifaki et al. 2025 finding should not be interpreted as a green light for early return without criteria. The study population was a highly supervised cohort at a FIFA Medical Centre of Excellence where rehabilitation completion was rigorously monitored. The finding applies specifically to athletes who met objective criteria - not to athletes who felt ready, or who had reached a particular time since surgery without completing the rehabilitation programme.

What Reduces Reinjury Risk Most Effectively

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The evidence on protective strategies for ACL reinjury is now substantial enough to give clinicians and patients specific, quantifiable guidance. The following strategies have the strongest support:

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Evidence-Based Risk Reduction Strategies

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Complete the rehabilitation programme. Kotsifaki et al. (2025): athletes who met discharge criteria were 6x more likely to return to pivoting sport. Rehabilitation completion is the single most important modifiable factor for both reinjury reduction and return-to-sport success.

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Achieve quadriceps strength symmetry of 90% or above. Grindem et al. (2016): more symmetrical quadriceps strength prior to return significantly reduced knee reinjury rate in the Delaware-Oslo cohort. This threshold is not arbitrary - it reflects the biomechanical loading protection that symmetrical quadriceps strength provides.

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Pass objective hop testing criteria. Passing a battery of functional hop tests is associated with lower second injury risk (Losciale et al., JOSPT, 2019; AOSSM 2025 review). No single test is sufficient - a multi-test battery is required.

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Wait at least 9 months before return to high-demand pivoting sport unless objective criteria are clearly and demonstrably met earlier. The Grindem 51% monthly risk reduction data remains valid for patients who have not completed objective criteria. Criteria first, calendar second.

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Assess and address psychological readiness. ACL-RSI below threshold predicts reinjury independently of physical testing. Rehabilitation programmes that do not include psychological readiness assessment are incomplete.

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Consider LET augmentation before reconstruction in high-risk patients. In patients under 25 with grade 2+ pivot shift returning to pivoting sport, STABILITY trial data shows LET halves re-rupture rates. This is a pre-operative decision but belongs in the reinjury risk conversation.

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The 84% Risk Reduction: The Delaware-Oslo Rules

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The single most cited finding in ACL reinjury prevention is the 84% risk reduction demonstrated by Grindem and colleagues in the Delaware-Oslo ACL Cohort Study (BJSM, 2016). The study tracked 106 patients who participated in pivoting sports in a prospective 2-year cohort and found that 38.2% of those who failed RTS criteria suffered reinjuries, versus only 5.6% of those who passed. It established that three specific decision rules, applied together, produced an 84% reduction in reinjury rate: delaying return for each additional month up to 9 months, achieving quadriceps limb symmetry of 90% or above, and passing functional hop testing criteria.

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What the Delaware-Oslo data revealed - and what makes it the landmark study it is - is that these rules are multiplicative, not additive. Athletes who delayed return, achieved strength symmetry, and passed hop tests had dramatically lower reinjury rates than those who satisfied only one or two criteria. The 84% figure represents the protection achievable when all three conditions are met simultaneously. Each criterion addressed a different mechanism of reinjury risk: the time criterion allows graft ligamentisation; the strength criterion restores biomechanical protection; the functional criterion confirms that strength translates to dynamic performance.

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It is worth noting explicitly what the Delaware-Oslo rules do not include: ACL-RSI psychological readiness, force plate assessment of landing mechanics, or neurocognitive evaluation. These were not components of the original 2016 criteria. The current evidence - particularly the Aspetar research programme - has expanded the return-to-sport testing battery substantially beyond what Grindem originally described. The 84% figure is the floor of what good practice can achieve, not the ceiling.

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Professional Football: Where the Risk Is Highest

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The context in which ACL reinjury risk is most acutely concentrated is professional football. Della Villa and colleagues, using UEFA Elite Club Injury Study data tracking 118 players (BJSM, 2021), found an overall second ACL injury incidence of 17.8% in professional male footballers returning to competitive play. In the highest-risk subgroup - players who had sustained a non-contact isolated index tear - 42% suffered a second ACL injury (11 of 26 players). This is not a statistical outlier. It reflects the environment most comprehensively: the highest physical demands, the most intense institutional pressure to return early, and the movement patterns most associated with ACL loading.

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The professional football context is described in depth on the Football-Specific ACL Rehabilitation page. What it illustrates for all patients is that the reinjury risk is not an abstract statistic. It is a clinical reality that has ended the careers of professional players, compressed the careers of many more, and continues to occur despite decades of research into how to prevent it. The protective strategies are known. The question is whether the rehabilitation programme delivers them rigorously enough.

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What Reinjury Risk Means at Atherapy

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At Atherapy, reinjury risk is not a topic reserved for the return-to-sport assessment conversation. It is the frame within which the entire rehabilitation programme is designed and delivered. From the first post-operative appointment, the strength criteria required for safe return, the timeline considerations appropriate to the individual patient profile, and the testing battery that will govern the discharge decision are all explained explicitly. Patients understand what they are working toward and why each criterion exists.

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The return-to-sport testing assessment at Atherapy incorporates the full multi-modal battery: VALD DynaMo quad and hamstring strength symmetry, the four standard hop tests, VALD ForceDecks force plate assessment of landing mechanics and reactive strength, and the ACL-RSI psychological readiness scale. No single criterion gates discharge. The clinical picture is considered as a whole, weighted against the individual patient's risk profile - age, sport, graft type, timeline, and psychological status. For patients in higher-risk groups - under 25, returning to pivoting sport, with prior reinjury history - the threshold is higher and the criteria are applied more rigorously.

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For patients who need to understand their individual risk profile in detail, Andrew Balderston offers a specific reinjury risk consultation as part of the return-to-sport assessment. This applies the risk stratification framework to the individual patient, identifies which risk factors are present and which are modifiable, and designs the final rehabilitation and return-to-sport plan around them.

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Related Pages in the ACL Rehabilitation Series

→ Return to Sport Testing

→ Force Plate Testing

→ Quadriceps Weakness After ACL Injury

→ Psychological Recovery After ACL Injury

→ Graft Choice Considerations

→ Football-Specific ACL Rehabilitation

→ Gym-Based ACL Rehabilitation

→ ACL Rehabilitation Timelines

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Reinjury Risk Assessment and Return-to-Sport Testing - Atherapy

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If you are approaching return to sport after ACL reconstruction and want an objective, evidence-based assessment of your readiness and your reinjury risk profile, book a comprehensive return-to-sport testing session at Atherapy. Our assessment incorporates strength testing, hop testing, force plate analysis, and psychological readiness evaluation - interpreted against your individual risk factors by Andrew Balderston, Clinical Director.

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Book at your nearest clinic: Moorgate | Strand | Chiswick

Frequently Asked Questions

References

Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine. 2016;50(13):804-808.
Kotsifaki R, King E, Bahr R, Whiteley R. Is 9 months the sweet spot for male athletes to return to sport after anterior cruciate ligament reconstruction? British Journal of Sports Medicine. 2025;59(9):667-675. doi:10.1136/bjsports-2024-108733.
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. American Journal of Sports Medicine. 2016;44(7):1861-1876.
Piussi R, Simonson R, Zsidai B, Grassi A, Karlsson J, Della Villa F, Samuelsson K, Senorski EH. Better safe than sorry? A systematic review with meta-analysis on time to return to sport after ACL reconstruction as a risk factor for second ACL injury. Journal of Orthopaedic and Sports Physical Therapy. 2024;54(3):161-175.
Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk factors for ipsilateral versus contralateral reinjury after ACL reconstruction in athletes: a systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine. 2023;11(12):23259671231214298.
Della Villa F, Hagglund M, Della Villa S, Ekstrand J, Walden M. High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study. British Journal of Sports Medicine. 2021;55(23):1350-1356.
Yang JS, Prentice HA, Reyes CE, Lehman CR, Maletis GB. Risk of revision and reoperation after quadriceps tendon autograft ACL reconstruction compared with patellar tendon and hamstring autografts in a US cohort of 21,973 patients. American Journal of Sports Medicine. 2024;52(3):670-681.
Losciale JM, Zdeb RM, Ledbetter L, et al. The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2019;49(1):43-54.
Sonesson S, Gauffin H, Kvist J. The role of psychological readiness in return to sport assessment after anterior cruciate ligament reconstruction. American Journal of Sports Medicine. 2021;49(6):1500-1508.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. American Journal of Sports Medicine. 2014;42(7):1567-1573.
Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 2023;57(9):500-514.

London Physiotherapy Team

Welcome to the Atherapy expert clinical team. We are a dedicated group of qualified physiotherapists and sports medicine specialists committed to delivering innovative, evidence-based rehabilitation. Our practice is built on a holistic approach to physical health, firmly believing that injury prevention is just as vital as the cure. From treating acute sports injuries to designing custom performance optimization programs, our clinicians work collaboratively to help you safely reach your goals.

Meet our resident experts below and find the right specialist for your recovery journey.

With 25+ years of Premier League and Championship experience, Andrew has led Medical, Science, and Performance departments for Hull City, Nottingham Forest, Derby County, and Preston North End, following earlier work at the Manchester United Academy
Specialist in lower limb rehabilitation
Post-operative rehabilitation
Back pain and complex spinal presentations
Elite athlete management including manual therapy, gym rehabilitation and acupuncture
Specialises in complex cases and second opinion rehabilitation planning including return to play
Limited clinical availability due to wider clinical leadership and operational responsibilities

Andrew Balderston

MSc, MCSP, BHSc, CSCS

COO/Senior MSK Specialist Physiotherapist
Based at Moorgate

Book an appointment with Andrew

Specialist in exercise-based rehabilitation, manual therapy and injury prevention
Experienced in post-operative rehabilitation and progressive return to activity
Clinical interests include sports injuries, cervical spine and low back dysfunction, shoulder, knee, foot and ankle rehabilitation
Combines hands-on treatment with targeted strength and rehabilitation programming
Focused on structured rehabilitation to help patients rebuild strength, movement confidence and function
Specialist interest in women’s health support including manual lymphatic drainage during pregnancy and pre/post-natal care
Over 15 years of clinical experience across private practice, sports rehabilitation and women’s health settings
Fluent in English, Portuguese and Italian

Fernanda Saldanha

BSc, MCSP, HCPC

Senior MSK and Specialist Physiotherapist
Based at Chiswick

Book an appointment with Fernanda

Extensive experience working within elite professional football and private practice
Former Tottenham Hotspur Academy physiotherapist specialising in performance rehabilitation and return-to-play management
Specialist interest in post-operative rehabilitation and upper and lower limb injury management
Experienced in managing complex and recurrent injuries through structured, evidence-based rehabilitation planning
Clinical approach combines manual therapy, gym-based rehabilitation, movement analysis and acupuncture
Focused on restoring movement quality, strength under load and long-term performance outcomes
Fluent in English and Greek

Dimitrios Michtatidis

MSc, MCSP, HCPC

Senior MSK and Sports Physiotherapist
Based at Chiswick and Strand

Book an appointment with Dimitrios

Level 4 Strength & Conditioning Coach
Medical Acupuncture & Dry Needling Qualified
Combines detailed clinical assessment with progressive rehabilitation and strength & conditioning principles
Specialist interest in gym-based rehabilitation and return-to-sport management
Clinical interests include acute sporting injuries, post-operative orthopaedic rehabilitation (including ligament reconstructions, meniscal and labral repairs) and hip/groin pain in active populations
Experience managing both active general population and performance-focused clients
Adjunct treatment techniques include dry needling and shockwave therapy

Claire Cuffe

MSc Physiotherapy

Senior MSK Physiotherapist
Based at Moorgate and Strand

Book an appointment with Claire

Over 5 years experience treating orthopaedic injuries, chronic pain and post operative care
Advanced certifications in dry needling for hands, face, feet, lower limb, upper limb and lumbopelvic region
Certified pelvic floor physio for both men and women with an interest in treating clients pre and post natal
Special interest in strength and conditioning programming for clients training for half/full marathons