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Returning to preinjury level of sports participation is a primary goal of anterior cruciate ligament reconstruction (ACLR). Indeed, surgical success is often judged on return-to-sport rates. While timeframes of 6–12 months postsurgery are typically expected, in reality, fewer than two-thirds of individuals return-to-sport within the first year post-ACLR.1 Conservatively managed individuals have similar clinical outcomes—future knee function relies on optimal rehabilitation, irrespective of surgery.2 Although consensus for the most effective rehabilitation approach is lacking, contemporary treatment programmes worship at the altar of accelerated return-to-sport.
Although the finish line for ACL rehabilitation is often defined as resuming sporting pursuits, consequences of ACL injury, including the high reinjury and contralateral injury risk, extend for many years, possibly a lifetime. Radiographic knee osteoarthritis (OA) is inevitable for 50–60% of individuals ≥10 years post-ACL injury and reconstruction.3 Given that typical ACL injured patients are young, this early-onset OA often engenders considerable morbidity and impact on healthcare resources. Could our short-sighted fixation on a fast-tracked return-to-sport be linked to these alarming premature OA rates?