Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL Injury, Part 1: Optimizing Recovery in the Acute Post-Operative Phase- A Clinical Commentary

Abstract

Anterior cruciate ligament (ACL) injury rates are on the rise, despite improved surgical techniques and prevention programs. While traditional rehabilitation emphasizes the restoration of motion, strength, and physical performance, emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury. These deficits, including altered proprioception, impaired motor control and muscle recruitment, as well as heightened reliance on visual feedback, can significantly increase the risk of re-injury and impede return to sport. The purpose of this clinical commentary is to outline a proposed comprehensive approach to rehabilitation that challenges the neurocognitive system to optimize rehabilitation outcomes and reduce reinjury risk. Thus, this clinical commentary discusses the rationale for integrating neurocognitive training into all phases of ACLR rehabilitation, from initial injury to eight weeks post-surgery. It details the neurophysiological changes caused by ACL injury and presents evidence supporting the use of exercises that challenge visual attention, decision-making, and motor planning. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve long-term outcomes and reduce re-injury risk. Level of Evidence: 5