Currently there is not a heavy focus on the quality of movement nor the cognitive side of recovery. The main focus is literal function as decided by quad strength, ROM, and running/jumping agility exercises. This is not sufficient for athletes working to compete at high levels as they were before or strive to in the future. There is a disregard for patient input and personal readiness which can hinder an athlete's ability to return as confidently and safely.

There needs to be much heavier focus on the cognitive side of the patient's recovery as well as making sure that the movements they are doing are of high quality and are not just completing basic tasks. Many athletes report being scared to reinjure themselves, and that's because during their rehab, the cognitive side is not considered as highly. Also, a study showed that when people used VR while doing rehab to simulate a different environment and terrain to do training on, their performance visibly decreased. During rehab, athletes are not thinking about a goal other than completing a movement while in sports, the movement is passive to thinking about the goal. This can lead to reinjury when athletes attempt to do that without having done it since before surgery.

All of these factors point to a need to include dual training, which includes cognitive training and motor training in the same exercises. This better prepares athletes to return to sports, especially ones where quick agility is needed without thinking about it. 

The following should be implemented into rehab training and workouts:

• Adding cognitive tasks for the athlete to complete while doing movements that support ACL recovery and RTS, including:

  • On the fly change of direction

  • Doing math/spelling

  • Light up dots that an athlete has to touch

  • Image/number/word recall

These can be used to reevaluate reaction time, motor movement, quality of movement, and whether or not an athlete is prepared to RTS soon. If an athlete is moving in a way that protects the knee, that means that they are afraid to reinjure and are not ready to RTS. These dual tasks - cognitive and motor/movement - allow for athletes to better prepare for quick agility and contact sports without as high of a risk of reinjury. The athlete needs to be prepared mentally just as much as physically - they can't be afraid to reinjure the ligament. While no method has a 100% success rate, this training program will best equip athletes to safely RTS without fear or high risk of another tear.