ACL Rehabilitation Plateaus Across Athlete Populations: Two Case Reports and a Clinical Framework for Identifying Functional Stagnation.

Two patients, each with a different problem and a different programme, so nothing here shows that any treatment works. No validated patient-reported outcome measures were used, and motivation, fear and confidence were judged clinically rather than measured with a scale. Follow-up was short to medium term; long-term sport participation and re-injury risk were not assessed. Both athletes received several treatments at the same time (resistance training, aquatic therapy, and in the second case perceptual-neurocognitive and position-specific drills), so the contribution of any one cannot be separated. The treating team both chose and delivered the interventions and judged the outcomes, so improvement after the programme changed may reflect something other than the change. Strength in the first case was tracked partly by thigh girth, which the authors state does not directly measure muscle strength or neuromuscular control.

The authors declare no conflict of interest and no external funding. The paper does not describe any role for a sponsor, since there was none.

Do not read the second athlete's return to competitive football as proof that perceptual-neurocognitive training overcomes an ACL rehabilitation plateau, or the first athlete's outcome as proof that fear of heavy weights causes one. Each is a single patient who received several treatments at once, with no comparison group, and the treating therapists both chose the programme and judged whether it worked.