Shifting Focus: A Clinician's Guide to Understanding Neuroplasticity for Anterior Cruciate Ligament Rehabilitation

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Abstract
Neuroplasticity after anterior cruciate ligament (ACL) injury has lingering effects throughout rehabilitation and can influence reinjury risk upon returning to sport if not addressed. Various neural compensatory strategies have been identified following ACL injury, which appear to not be rectified with typical therapy. Thus, further consideration is warranted, addressing the neurophysiologic and neurocognitive aspects of injury when developing a rehabilitation program. Integration of external focus of control strategies, neurocognition, motor planning, unanticipated sensory processing, and load management provide an efficient and effective method for improving motor learning and control throughout the rehabilitation process. Rehabilitation exercises that incorporate unique sports-specific challenges can target the visual processing and anticipatory reaction components of motor control to reduce motor errors that increase injury risk when returning to activity. The neurocognitive demands of returning to sport of efficient decision making and motor patterning amid a rapidly changing competitive environment require novel and clinically implemental strategies.

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