When to Start Plyometric Training After Anterior Cruciate Ligament Reconstruction? A Systematic Review of Randomized Clinical Trials

CONTEXT: Injury to the anterior cruciate ligament (ACL) causes substantial long-term disabilities for athletes. Exercise methods like plyometrics have been considered ideal due to their neuromuscular and motor control benefits. OBJECTIVE: This systematic review aims to provide practitioners with criteria for starting to perform plyometric training exercise (PTE) after ACL reconstruction (ACLR). DATA SOURCES: A review of relevant literature was conducted using PubMed, Cochrane Library, and PEDro. STUDY SELECTION: Based on a set of criteria, only relevant randomized controlled trials were included in the study from inception to March 18, 2026. STUDY DESIGN: Systematic review of randomized clinical trials. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: An appropriate form was developed and tested for collecting data from the literature to answer the current question. As part of the risk of bias assessment, an updated version of the Cochrane tool was used, and the GRADE approach was applied. RESULTS: Of the studies' outcomes, 63% raised some concerns about bias. Across 16 studies, 685 participants (70% men, 30% women) were included, with a mean age of 25.23 years. PTE began on average after 13.50 weeks post-ACLR as reported in 14 studies. A number of criteria were considered when starting PTE, including clinical, strength, performance, biomechanics, and patient-reported outcomes. CONCLUSION: Programs of plyometric training have been reported to start on average 13.50 weeks after ACLR. There is still a need to conduct more research to establish the validity of the proposed assessment criteria to start plyometric exercises in a safe manner. This study's findings may enable PTE to be implemented more practically in ACL rehabilitation programs, which reduces the gap between research and practice.