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1Introduction19Rehabilitation and Return to Sports after ACL ReconstructionRehabilitation after ACL injury – with or without reconstruction –- has a noticeable effect on functional outcome.2,18 It is therefore important not to solely focus on the surgical aspect of ACL reconstruction, but also to optimise the rehabilitation process after the intervention. ACL reconstruction is typically followed by a rigorous rehabilitation programme to enhance knee strength and function.2 ACL rehabilitation aims to prepare patients for return to daily activities, work and sports. Positive associations are shown between ACL rehabilitation and clinical outcome after ACL reconstruction.2 However, current postsurgical rehabilitation is considered ‘uniquely heterogeneous’.12 Favourable in the Dutch situation is the fact that a rehabilitation guideline for anterior cruciate ligament surgery has been published by the Royal Dutch Society for Physiotherapy.31 This guideline divides the rehabilitation process into three different phases. In the first phase the aim is to reduce effusion, regain range of motion and restore normal gait. In the second phase rehabilitation focuses on regaining strength and facilitating participation in sport-specific tasks and work. In the third and final phase comes preparation of the patient for return to sports and/or physically demanding work.31 In practice, this means that in the first weeks the focus will be on passive mobilisation of the knee done by the physiotherapist, possibly making use of electrical stimulation of the quadriceps. Over time, patients start cycling on a home trainer and perform strength exercises for the quadriceps, hamstring, calf and gluteal musculature (squatting, leg presses, etc.). Typically two physiotherapy sessions per week are needed at this stage. In phase 2 neuromuscular training including jumping and quick alterations of directions are introduced with and without distraction. In phase 3 individual on-field training is commenced.31 Overall, rehabilitation after ACL reconstruction takes another nine to twelve months after surgery and patient compliance with postoperative rehabilitation is a key factor in return to sports.6 Despite this, a recent report by Della Villa et al. shows that only 18% of patients are fully compliant and 27% are moderately compliant with rehabilitation after ACL reconstruction.6 High self-motivation, athletic identity, high selfefficacy, high self-confidence, positive self-talk and proper social support Mark Zee.indd 19 03-01-2024 08:56