From setback to comeback: key insights for a successful return to sport after a second anterior cruciate ligament...

To explore athletes' experiences, thoughts, and behaviors during the final phase of rehabilitation - transition from supervised to unrestricted rehabilitation and return to sport (RTS) - after a second anterior cruciate ligament reconstrcution (ACLR), and the strategies used to prevent reinjury at this phase of rehabilitation.

Qualitative descriptive study.

Competitive team ball sports.

Sixteen athletes (8 females, 18-30 years) who had RTS after their second ACLR.

Individual semi-structured interviews were conducted. Conventional content analysis generated categories capturing athletes' experiences.

Three main categories emerged: Safe reintegration into sports after the second ACLR, describing need for structured progression, sport-specific training and long-term injury prevention; Navigating physical and psychological readiness to return to sport, highlighting fluctuating confidence, fear of reinjury, and strategies to rebuild trust in the knee; and Unified approach to return to sport, emphasizing collaboration with physiotherapists and coaches, and athletes' increased self-awareness following their first ACLR rehabilitation.

Athletes adopted a more cautious, informed, and prevention-focused approach during their second ACLR rehabilitation, drawing on lessons from their first injury. Integrating psychological readiness with physical recovery, promoting communication between athletes, physiotherapists, and coaches, and emphazising injury prevention may enhance RTS outcomes after a second ACLR.