Anterior cruciate ligament (ACL) injury is common in athletic individuals and often leads to physical impairments, a low rate of return to performance, reinjuries, and sometimes reductions in career length

Background: Anterior cruciate ligament reconstruction (ACLr) often leads to asymmetries between limbs, with variable return-to-performance rates in athletes. The single-leg countermovement jump (SLCMJ) is commonly used to assess postoperative knee function. However, limited research has explored deficits specifically during the unweighting phase of the jump. Methods: This study assessed 53 recreational athletes (11 females, 42 males) between 6 and 9 months post-ACLr using a dual force plate system (1000 Hz). Each participant performed three maximal-effort SLCMJs per limb. Outcome measures included jump height, negative peak velocity, minimum force, and center of mass (COM) displacement. Paired t-tests and Wilcoxon tests were used to compare the ACLr limb with the contralateral limb. Results: Compared to the healthy limb, the ACLr limb showed significantly lower negative peak velocity (−0.80 ± 0.40 m/s vs. −0.94 ± 0.40 m/s, p < 0.001), higher minimum force (36.75 ± 17.88 kg vs. 32.05 ± 17.25 kg, p < 0.001), and reduced COM displacement (−17.62 ± 6.25 cm vs. −19.73 ± 5.34 cm, p = 0.014). Eccentric phase duration did not differ significantly. Conclusions: Athletes post-ACLr demonstrate altered neuromuscular control during the early SLCMJ phase. These findings highlight the importance of rehabilitation strategies targeting eccentric strength and symmetry restoration.

Background: Hamstring tendon autografts are frequently used for anterior cruciate ligament reconstruction (ACLR), but they are associated with persistent hamstring strength deficits and delayed functional recovery. Current rehabilitation guidelines often delay open kinetic chain (OKC) hamstring exercises due to safety concerns, despite the limited supporting evidence. This uncontrolled, underpowered, and exploratory study aimed to evaluate the safety and effectiveness of introducing OKC hamstring strengthening exercises as early as three weeks after ACLR. Methods: An exploratory retrospective observational study was conducted at a single physiotherapy center on 13 patients (aged 18–35) who underwent primary ACLR with semitendinosus–gracilis grafts. Participants followed a standardized rehabilitation program including isometric leg curls at 60° and 90° knee flexion and long-lever glute bridges twice weekly, starting from postoperative week 3. Safety was assessed through predefined “safety flags” (pain > 4/10, hematoma, clinical hamstring strain). Strength outcomes, including isometric knee flexion strength at 60° and 90°, limb symmetry index (LSI), and endurance tests, were assessed at 6 and 12 weeks. Results: All participants completed the program without major adverse events. Pain remained consistently low (median 2.5/10), with only one transient episode exceeding the threshold. No other complications were recorded. Isometric knee flexion strength significantly improved between week 6 and week 12 at both 60° (p = 0.018) and 90° (p = 0.003), with large effect sizes. LSI at 90° also increased significantly (p = 0.006), whereas improvements at 60° did not reach significance. Endurance testing showed functional gains as early as 6 weeks. Conclusions: The early introduction of OKC hamstring strengthening exercises three weeks after ACLR with hamstring autografts appears safe and promotes clinically meaningful improvements in strength and endurance. These findings, while from a small uncontrolled study, challenge conservative rehabilitation protocols and support the reconsideration of early hamstring loading. Given the retrospective, uncontrolled, and underpowered design, these findings are hypothesis-generating and not generalizable beyond young adults with hamstring autografts; larger randomized trials are required.

Background: Conventional rehabilitation after anterior cruciate ligament reconstruction often follows a rigid, phase-based model. This structure may overlook individual differences in healing, neuromuscular control, and psychological readiness, leading to low return-to-sport rates and a high risk of reinjury. Methods: This narrative review proposes a flexible rehabilitation framework based on overlapping progression blocks. Inspired by principles of strength and conditioning, motor learning, and cognitive training, this model emphasizes continuous, individualized development instead of fixed timelines. Results: The proposed model integrates essential components—such as joint mobility, muscle activation, motor control, and psychological factors—throughout the entire recovery process. Functional testing is redefined as a dynamic and ongoing diagnostic tool that helps clinicians identify areas needing further development, rather than acting as a simple pass/fail gateway. Progression is guided by demonstrated readiness rather than time or phase completion. Conclusions: Rehabilitation using adaptive, overlapping progression blocks offers a more holistic and responsive approach. It allows for better personalization, supports safer decision-making, and improves the transition back to sport through sustained development of physical and cognitive capacities.

Introduction: Anterior cruciate ligament (ACL) reconstruction involves prolonged rehabilitation, with Return to Sport (RTS) as a key goal for athletes. Integrating Dual Task (DT) strategies, which combine cognitive and physical tasks, is critical, as multitasking mirrors real-world and sports-specific demands. Assessing how distractions affect performance is essential to optimize RTS outcomes for both the reconstructed and healthy limbs. Purpose: To analyze the influence of DT on the performance of the Triple Hop Test for distance (THD) in individuals’ status post ACL reconstruction. Study type: Cross Sectional Materials and Methods: Seventeen patients post-ACL were recruited and performed THD under two conditions: single task (standard condition) and dual task (with an added neurocognitive task). Assessments were conducted on both the healthy and the previously injured limb over six meters, measured via a standard measuring tape. Paired t-tests and Mann-Whitney-Wilcoxon or Kruskal-Wallis tests were applied to investigate differences. Categorical variables were compared using chi-squared tests. Results: There was a significant difference in average distance between single task performances in the healthy and previously operated limbs, with a difference of 20.71 cm (p=0.016). A significant difference was also observed in DT performance, with a distance variation of 10.41 cm (p=0.038). Comparing performances, both the healthy and the ACL-reconstructed limbs showed performance deterioration under DT conditions, with a greater percentage decline in the healthy limb. Conclusions: Dual Task conditions appear to hinder performance in the THD in both the healthy and post-ACL reconstructed limbs. Level Of Evidence: 3b