Quality of Movement Assessment after ACL Reconstruction in Youth: A Clinical Framework to Guide Rehabilitation and Return-to-Sport Decision-Making

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries requiring surgical intervention in youth athletes. After ACL reconstruction surgery, youth athletes undergo prolonged rehabilitation which often concludes with return-to-sport (RTS) testing to determine the athlete's readiness to resume sports participation. Most rehabilitation and RTS literature have focused primarily on quantitative outcomes to guide these decisions. Given the relationship between trunk and lower extremity biomechanics with ACL injury risk, there has been a call to action for the inclusion of qualitative assessments in rehabilitation and return-to-sport assessments. The purpose of this commentary is to describe quality of movement assessment tools that can guide rehabilitation and RTS decision making in pediatric and adolescent patients following ACL reconstruction. Specifically, it provides a framework for the implementation and interpretation of tools to assess single-leg, double-leg, and change of direction tasks as well as practical strategies and considerations for their use with pediatric and adolescent patients after ACL reconstruction. # Level of Evidence 5