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General Discussion1859of the movement itself. Literally moving your body forward can make a psychological difference when comparing it to performing a leg press at the gym. By incorporating speed skating to ACL rehabilitation, more fun and higher compliance may be achieved. This study shows that it is feasible to look for alternative modes of rehabilitation outside the gold standard for rehabilitation after ACL reconstruction. This opens up the path towards individualised ACL rehabilitation, not only in terms of speed, frequency and intensity of exercises but also type of sports integrated within the rehabilitation programme.It has been suggested that a more holistic approach is needed towards ACL rehabilitation.15 It would therefore be useful to involve patients in designing their rehabilitation programme, within evidence-based boundaries. With further development of the KROS programme, patients can be offered a choice for their rehabilitation after ACL reconstruction. This sense of ownership and co-responsibility is important for patients.10,12A periodised rehabilitation programme aims to optimise the principle of overload.18 Hypothetically, by posing the challenge of ice skating the central nervous system is also overloaded and thus trained. It is important to include neurocognitive training over the course of the rehabilitation. As described in the section understanding the effects of ACL injury, the central nervous systems switches to alternative pathways at the moment of ACL injury. After ACL reconstruction, the central nervous system has to be trained just as much as the muscle strength of the leg. By introducing ice speed skating to rehabilitation after ACL reconstruction, the central nervous system is provided with new stimuli and motor learning may be stimulated. It has already been postulated that a focus on perturbation training, adding visual and auditive stimuli, distraction and multitasking can be helpful during the rehabilitation process to promote motor learning and potentially prevent secondary injury.16,19 All these factors can be combined in ice speed skating.With the KROS protocol, periodisation is applied not only physically but also mentally. This may enhance knee self-efficacy. We have seen that fear of reinjury, kinesiophobia, knee self-efficacy and psychological readiness Mark Zee.indd 185 03-01-2024 08:56