Rewiring recovery: Integrating sensory-motor-cognitive strategies to optimize ACL rehabilitation

Although advances in anterior cruciate ligament reconstruction (ACLR) techniques and rehabilitation protocols have improved physical recovery, many athletes return to sport with neuromotor deficits that increase reinjury risk. These limitations-altered sensory integration, excessive visual reliance, and inefficient motor strategies-reflect central neuroplastic adaptations rarely addressed in conventional rehabilitation. This clinical commentary explores how applying motor learning principles and sensory-motor-cognitive strategies may rewire recovery, enhance adaptability, and improve athletic readiness following ACLR. Rehabilitation emphasizing an external focus of attention improves movement efficiency and neural processing, while variable practice enhances adaptability by exposing athletes to changing task and environmental demands. Differential learning, in which repetition is intentionally varied, uses movement variability to strengthen error detection and correction under dynamic constraints. The integration of sensory challenges-such as virtual reality, stroboscopic vision, or wearable biofeedback-supports proprioceptive reweighting and perception-action coupling. Collectively, these approaches shift rehabilitation from prescriptive repetition toward enriched practice environments that better reflect sport demands. By prioritizing adaptability rather than repetition, clinicians may promote more automatic, resilient, and context-specific movement behaviors that support safer and more sustainable return to sport outcomes.