From linear rehabilitation to graded stress exposure: A clinical framework for return to sport after anterior cruciate ligament reconstruction

Abstract

Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction remains associated with a substantial risk of reinjury despite advances in surgical techniques and rehabilitation protocols. Contemporary rehabilitation strategies primarily focus on restoring strength, range of motion, and neuromuscular control under controlled conditions. However, emerging evidence suggests that performance in standardized functional tests does not necessarily reflect an athlete's ability to tolerate the dynamic, unpredictable, and cognitively demanding environment of competitive sport.