Nicky van Melick

Anterior cruciate ligament reconstruction rehabilitation: decades of change

Several rehabilitation guidelines for athletes with an ACL reconstruction have been published over the past decades. However, as new literature continues to emerge, there is an ongoing need to update these guidelines. The current guidelines lack advice on three key elements of rehabilitation: open-chain quadriceps strength training, neurocognitive training and testing, and psychological interventions. This editorial discusses why these three elements should be included in future guidelines.

Open Kinetic Chain (OKC) Quadriceps Strengthening
OKC exercises have been shown to improve quadriceps strength without compromising graft integrity when properly monitored. Combining OKC with closed kinetic chain (CKC) exercises may optimise recovery.

Neurocognitive Training & Testing
Athletes with ACL injuries exhibit altered brain function, which persists even after rehabilitation. Training and testing targeting reaction time, visual attention, and dual-tasking could reduce reinjury risk but is still underutilised in clinical practice.

Psychological Interventions
Psychological readiness plays a crucial role in return to sport, but current guidelines provide limited guidance on assessment and intervention. Patient-reported outcomes (PROs) are useful but require better integration into individualised rehab plans. Info about psychological interventions that might be applied during rehabilitation are overlooked in existing literature

Reference:

• van Melick N, Senorski EH, Królikowska A, Prill R. Anterior cruciate ligament reconstruction rehabilitation: decades of change. Knee Surg Sports Traumatol Arthrosc 2025, feb 10. Online ahead of print. DOI: 10.1002/ksa.12600.