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Knee Rehabilitation on Skates1518IntroductionRupture of the ACL is a common injury, occurring primarily in young athletes participating in pivoting sports like soccer, football, handball and field hockey.2 The incidence of ACL rupture is estimated at 81:100.000.9As described in the Dutch guideline on ACL injury, surgery is indicated in patients with persistent instability after six to 12 weeks of conservative therapy.17 Especially in young athletes the treatment of choice is an ACL reconstruction (ACLR). Objective outcome of ACL reconstruction can be divided in technical success (re-rupture rate, residual instability) and functional success. Functional success is often measured using a hop test battery including the one legged forward hop test, side jump and single leg balance test. Based on these tests a limb symmetry index (LSI) can be calculated by comparing the involved leg to the contra-lateral intact leg. A functional LSI of 85-95%, nine months after ACL reconstruction has been postulated to be a successful result.12 A successfully performed functional test is highly related to return to sports.22In the population of young athletes, return to sports has become the most relevant outcome after ACLR. Return to sports after ACLR is commonly allowed once a LSI of 90% has been achieved. This mostly takes up nine to twelve months after surgery and consists of lots of hours in the gym, training on quadriceps and hamstrings strength. A review of literature has shown that a mere 55% of athletes are able to return to a competitive form of sports after an ACLR.3 Surgical technique or choice of graft has been shown not to influence the rates of return to sports, but it has been shown that compliance to ACL rehabilitation protocols has a positive influence.5,10Main factors influencing compliance to rehabilitation have been shown to be mood, pain and stress.5 As the majority of patients tearing their ACL participate in pivoting sports, predominantly soccer, current rehabilitation programmes focus on return to pivoting sports.2 Before actual field training can commence, lots of hours are spent in the gym to regain knee strength. Incorporating another activity, like speed skating, early in the rehabilitation Mark Zee.indd 151 03-01-2024 08:56