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Knee Rehabilitation on Skates1638The continued provision of challenges during the rehabilitation programme has proven to be important for recovery after ACL reconstruction.16 This process of periodization comes into its own during the KROS protocol. With the KROS programme, sensory and cognitive stimulation and motor learning is promoted. Another possible advantage could be the fact that patients get in touch with a different kind of sport with a lower risk of ACL injury. If patients decide to stick to skating, re-injury of their reconstructed ACL might be prevented. If patients decide to stop skating, they may have developed into a more all-round athlete who, for instance, can play football at an increased level.To our knowledge there is only one other report that comprehensively describes on-ice training after ACL reconstruction. Capin et al6 described general guiding principles for the return on ice after ACL reconstruction. Most of our KROS programme was based on the work of Capin et al. They included a case description of 1 patient including quadriceps strength, hoptests battery and a limb symmetry index. They reported a quadriceps strength index of 88% at 7 months after surgery, 97% after 8.5 months after surgery and 94% 11 months after surgery. We have observed similar results with a mean quadriceps strength index in the KROS group of 108% after both 6 and 9 months after surgery and 101% 12 months after surgery. Capin asked his patient to complete the Knee Outcome Score (KOS) ADL subscale at 7.5, 8.5 and 11 months after surgery. Patient reported outcome improved from 80% at 7.5 months to 93% at 11 months after surgery.6We have used a different questionnaire to test subjective knee symptoms during daily activities. Our participants reported a mean score of 81 points on the IKDC-questionnaire at 6 months after surgery, which improved to 87 at 12 months after surgery. In the KROS group, the mean outcome is comparable to previous studies reporting on outcome after ACL rehabilitation. In our study, the mean ACLRSI score in the KROS group was 76 (SD 7) which is higher than reported by Webster in a large cohort of 635 patients that followed routine ACL rehabilitation.22 Is has to be noted that in the cohort of Webster et al, only 25% of patients had returned to a competitive form of sports. A recent review of literature that assessed knee self-efficacy in ACL injured patients Mark Zee.indd 163 03-01-2024 08:56