Recovery after ACL injury and reconstruction or repair and rehabilitation has come a long way over the last four decades evolving from an extra-articular arthrotomy with overnight hospitalization followed by 6 weeks of immobilization prior to initial physiotherapy, to an intra-articular arthroscopic procedure with early weight-bearing and mobility, and immediate outpatient rehabilitation. Rehabilitation approaches have similarly evolved from slowly progressing less complex range of motion and strength-training exercises to greater consideration of neuromuscular function such as lower extremity rate of force/torque development, kinesthesia, coordination, and psychosocial, environmental, and many other potential factors. Determining the appropriate time to release an athlete who has sustained an ACL tear back to competition is not easy. The traditional focus on knee range of motion, laxity, and strength has been superseded by concerns related to the reestablishing sufficient lower extremity power, neuromuscular control-dynamic knee stability, decreasing kinesiophobia, and increasing task self-efficacy as well as reestablishing knee region tissue homeostasis, graft remodeling and ligamentization, and physiological system readiness. Overarching the biological, biomechanical, and behavioral factors of return to competitive sports readiness is the patient-athlete’s psychological status, which may be the most difficult component to accurately evaluate and treat. All too often, athletes are ill-pre pared for returning to competition following rehabilitation. Evidence-based criteria need to be established to better insure athlete safety from each perspective when determining appropriate release back to competitive sports timing.