IJSPT case series: Functional lower-extremity exoskeleton aids golfers' return-to-sport

The International Journal of Sports Physical Therapy published two papers on September 1 that press the same point from different injuries: return-to-sport decisions should be tied to task-specific testing, not calendar milestones. One paper is a case series on the Functional Lower Extremity Evaluation, or FLEE, after hip arthroscopy in collegiate athletes. The other is a clinical commentary proposing a staged return-to-golf progression after anterior cruciate ligament reconstruction, or ACLR. Together, they add sport- and task-based benchmarks to a part of rehab that is often still driven by time since surgery. ### Why are these two papers being discussed together? The September 2026 IJSPT issue includes both the FLEE case series and the golf-after-ACLR paper. The journal’s issue listing names the hip-arthroscopy article by Yazdan Raji, Rebecca E. Luft, Kinsley J. Pierre, Floyd VitoCruz and Marc R. Safran, alongside the golf paper by Sean Hazzard, Michael Young, Danielle Lonati and Peter Asnis. (ijspt.scholasticahq.com) The overlap is methodological. The golf paper says no validated return-to-golf protocol after ACLR had been published, and that general return-to-sport timelines do not account for swing volume, club progression, lead- versus trail-knee demands, or return-to-course exposure. The FLEE study, described in conference and journal materials as a proof-of-concept effort after hip arthroscopy for femoroacetabular impingement, similarly centers return-to-sport on a structured lower-extremity test battery. (ijspt.scholasticahq.com) ### What exactly is the FLEE? The Functional Lower Extremity Evaluation was developed by sports medicine clinicians at Stanford University as a 45-minute battery of eight standardized functional performance tests. A 2014 JOSPT reliability study said it measures three components of lower-extremity function: control, power and endurance. The newer hip-arthroscopy case series applies that framework to collegiate athletes after surgery for femoroacetabular impingement. (ijspt.scholasticahq.com) Available abstracts describe a retrospective review in which postoperative FLEE testing was used to assess lower-limb function and symmetry as part of return-to-sport rehabilitation. ### What did the golf paper add after ACL reconstruction? Sean Hazzard and co-authors wrote that the golf swing places multiplanar loads across both knees, despite golf often being treated as a low-impact sport. (jospt.org) Their review found no prospective study evaluating a staged return-to-golf protocol after ACLR. (academic.oup.com) The paper proposes a six-phase progression from putting to unrestricted course play. According to the abstract, that progression uses symptom and range-of-motion requirements, objective strength and movement criteria, prescribed swing volumes, and separate considerations for the lead and trail knee before a return-to-course phase. (ijspt.scholasticahq.com) ### Why does that matter for clinicians? The golf paper states that return to golf after ACLR should be managed as a continuum rather than a single clearance decision. That framing aligns with older criteria-based hip-arthroscopy guidance in IJSPT, which identified range of motion, strength, functional testing, self-reported outcomes, psychological readiness and time as key elements in return-to-sport testing after hip arthroscopy. (ijspt.scholasticahq.com) A 2020 review on lower-extremity functional performance tests said such tests are used to identify deficits in physical qualities and neuromuscular control. In practice, these September IJSPT papers push that logic further into sport-specific progression: golfers are advanced by swing and knee-loading demands, while post-arthroscopy athletes are assessed with an established lower-extremity battery rather than by elapsed weeks alone. (ijspt.scholasticahq.com) ### Is there evidence here for a lower-extremity exoskeleton? The available journal records for these two papers do not mention a lower-extremity exoskeleton. The hip paper centers the FLEE test battery after hip arthroscopy, and the golf paper centers a six-phase rehabilitation progression after ACLR. (pubmed.ncbi.nlm.nih.gov) Because the source material available online does not support an exoskeleton angle, the cleaner reading is narrower: these papers are about objective testing and staged, sport-specific progression. The next place to watch is the full September 2026 IJSPT issue, where both articles are listed and where any subsequent letters, citations or follow-up case reports would appear. (ijspt.scholasticahq.com 1) (ijspt.scholasticahq.com 2)