Motor learning principles during rehabilitation after anterior cruciate ligament injury: Time to create an enriched environment to improve clinical outcome

Athletes who wish to resume high-level activities after an injury to the anterior cruciate ligament (ACL) are often advised to undergo surgical reconstruction. Nevertheless, ACL reconstruction (ACLR) does not equate to normal function of the knee or a reduced risk of subsequent injuries. A rising concern is the high rate of secondary ACL injuries, particularly in young athletes, with up to 40% of those returning to sport in the first year after surgery experiencing a second ACL rupture. Aside from the increased risk of secondary injury, patients after ACLR have an increased risk of developing early-onset osteoarthritis. Unfortunately, current ACLR rehabilitation programs may not be optimally effective in terms of addressing deficits related to the initial injury and the subsequent surgical intervention. Motor learning to (re)acquire motor skills and neuroplastic capacities are not sufficiently incorporated during traditional rehabilitation, attesting to the high reinjury rates. The purpose of this article is to present novel clinically integrated motor learning principles to support neuroplasticity that can improve patient functional performance and reduce the risk of secondary ACL injury. The novel motor learning principles presented in this manuscript may optimize future rehabilitation programs to reduce the risk of secondary ACL injury and early development of osteoarthritis by targeting changes in neural networks.