Recommendations for Movement Re-training After ACL Reconstruction.

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation Science

Background:

• Major injuries like anterior cruciate ligament reconstruction (ACLR) necessitate optimized functional recovery for improved patient outcomes.
• Movement quality deficits are prevalent in ACLR patients nearing return-to-sport (RTS), correlating with poorer long-term results.
• Current rehabilitation often lacks specific guidance on the 'how' and 'what' of effective post-ACLR movement retraining.

Purpose of the Study:

• To discuss factors influencing movement dysfunction and retraining post-ACLR.
• To provide clinicians with actionable recommendations for restoring patient movement quality before RTS.
• To bridge the gap between understanding the importance of movement retraining and its practical implementation.

Main Methods:

• Review of factors influencing movement quality, including individual (neuromuscular, biomechanical, sensorimotor, neurocognitive), task-specific, and environmental constraints.
• Proposal of a three-stage movement retraining framework integrated with the ACLR functional recovery process.
• Emphasis on progressive, realistic training environments simulating sport-specific demands.

Main Results:

• Movement quality is multifactorial, influenced by intrinsic and extrinsic patient-specific factors.
• A structured, three-stage approach is recommended: (1) addressing foundational control factors, (2) progressive functional task retraining, and (3) sport-specific on-field integration.
• Effective program design involves load management, coaching, feedback, and qualitative movement analysis.

Conclusions:

• Restoring optimal movement quality is essential for successful RTS after ACLR.
• Clinicians should adopt a comprehensive, staged approach considering all influencing factors.
• Tailored movement retraining programs enhance functional recovery and patient outcomes post-ACLR.