Surgeons, physical therapists, athletic trainers, and (especially) patients all know that ACL injury, reconstruction, and rehabilitation fall short of perfect. It's true. Our treatments fail to adequately restore knee function, prevent re-injury, or stave off knee osteoarthritis. 

A key example of this is characteristic quadriceps weakness. There is no injury to the quadriceps muscle, yet the typical patient won’t recover quadriceps strength for years. Our historically muscle-focused treatments (e.g., exercise) fail to address the source of the problem (e.g., neural inhibition). This is the primary reason early impairments are habituated into long-term deficits. 

Relatedly, our clinic-based largely “pre-planned” rehabilitation techniques and test batteries have questionable validity when it comes to preparation for sport. 

As patients, clinicians, and scientists, the sooner we accept these facts and recognize the complexity of these problems, the sooner we can solve them. No one thing can fill this gap. Conversation and study of anatomical risk factors and surgical techniques, biomechanics, therapeutic modalities, and rehabilitation approaches are necessary, but not sufficient.

This blog series will outline the complexities plaguing ACL injury and recovery by diving into the topics of biopsychosocial factors, changes in the nervous system, and on-field dynamics. We hope it will expand the dialogue between the clinicians and researchers charged with developing the future of ACL rehabilitation.