🎯 Título: «Estancamientos» en la rehabilitación tras reconstrucción de LCA
📌 En breve: Dos reportes de caso describen períodos de estancamiento funcional durante la rehabilitación de LCA y proponen un marco clínico para identificarlos, con mejoría tras ajustar el tratamiento.
🔬 Puntos clave:
### Dos casos, no un estudio poblacional
Se describen dos casos: un jugador recreativo de bádminton de 36 años con resistencia psicológica al entrenamiento de carga y adherencia inconsistente, y un futbolista subélite de 16 años con una interrupción de 3 meses en su rehabilitación formal. Ambos mostraron un estancamiento —persistencia de déficits de fuerza y control— identificado mediante evaluaciones repetidas, más allá de los 7 meses posoperatorios.
### Qué se hizo
Tras modificar el tratamiento —incorporando terapia acuática para facilitar la tolerancia a la carga y entrenamiento perceptual-neurocognitivo para el control del movimiento— ambos casos mostraron mejoría en la simetría de fuerza, el desempeño en tareas dinámicas y actividades funcionales deportivas.
### La propuesta de los autores
Los autores proponen que estos «estancamientos» son un fenómeno clínico poco reconocido, y plantean avanzar hacia una rehabilitación centrada en resultados y personalizada, en lugar de basada únicamente en cronogramas fijos.
🎯 Aplicación clínica para LATAM: Fisioterapeutas deportivos de la región pueden usar este marco conceptual para identificar tempranamente estancamientos en pacientes con recuperación post-LCA más lenta de lo esperado, aunque las estrategias descritas (terapia acuática, entrenamiento perceptual-neurocognitivo) se probaron en solo 2 casos.
⚠ Limitaciones: Se trata de una serie de solo 2 casos retrospectivos, sin grupo de comparación, por lo que no permite establecer que estas intervenciones sean efectivas de forma generalizable.
Background and purpose
Anterior cruciate ligament (ACL) rehabilitation typically follows a structured protocol for progressive recovery. However, not all subjects achieve expected functional milestones, despite adherence. Rehabilitation plateaus-defined as stagnation in physical progress-are often underrecognized in musculoskeletal cases. The concept of rehabilitation plateaus remains underexplored in musculoskeletal physiotherapy, particularly in ACL reconstruction recovery. The purpose of this case series was to explore clinical rehabilitation plateaus that occur during ACL reconstruction recovery, an underrecognized phenomenon in sports rehabilitation. # Design Retrospective case series. # Case DescriptionThe first subject was a 36-year-old recreational badminton player who exhibited psychological resistance to load training and inconsistent rehab compliance. The second was a 16-year-old sub-elite football (soccer) player who experienced a three-month interruption in formal rehabilitation following early discharge from club-based care. In both cases, rehabilitation plateaus were identified as the persistence of deficits in unilateral strength, dynamic control, and return-to-sport progression, based on repeated objective assessments including muscle strength testing, balance tasks, and functional running and sport-specific criteria.
Outcomes
Both subjects demonstrated a period of stagnation during the transition from isolated strengthening to functional and sport-specific rehabilitation phases. This was identified through repeated physiotherapist-led assessments showing persistent quadriceps and hamstring strength asymmetry, reduced single-limb control, and delayed progression toward return-to-sport criteria beyond seven months post-operatively. Following targeted rehabilitation modifications-including aquatic therapy to facilitate load tolerance and perceptual-neurocognitive training to address movement control and decision-making, improvements were observed in strength symmetry, dynamic task performance, and functional sport-related activities.
Conclusion
Rehabilitation plateaus represent a significant yet underrecognized challenge in ACL recovery. These clinical checkpoints often arise from mismatches between stimulus and readiness require adaptive, athlete-specific strategies to overcome. Adaptive strategies beyond standard protocols such as contextual movement planning, progressive overload, and perceptual training-may help resolve these plateaus and optimize outcomes. These cases emphasize the need to evolve beyond timeline-driven rehabilitation and embrace outcome-centered, personalized care in ACL physiotherapy.
Cómo citar:
Ram Kumar E, R S, Khristi JJ, Mathipriya K, Nivetha R, Ubaithullah AB. (2026).
ACL Rehabilitation Plateaus Across Athlete Populations: Two Case Reports and a Clinical Framework for Identifying Functional Stagnation.. International journal of sports physical therapy.
DOI: 10.26603/001c.156102 ↗ PMID: 41777434 ↗ Acceso al paper: Ver completo ↗
