The goal of this presentation is to reach clinicians and update the field with the latest understanding of return-to-play decision-making following knee injury. Clearance is too often based on time from surgery or limb symmetry alone, without fully characterizing muscle capacity, contraction-specific deficits, or psychological readiness. Without objective diagnostic testing, clinicians risk progressing athletes without clearly identifying what deficits remain. This presentation will emphasize measurable performance testing and psychological assessment as essential tools to guide rehabilitation progression, target identified weak links, and support more informed return-to-play decisions.

Atrophy that occurs after anterior cruciate ligament (ACL) injury continues despite being actively engaged in exercise. Recognizing the multitude of factors and cascade of events that are present and negatively influencing the regulation of muscle mass after ACL injury will likely enable clinicians to design more effective interventions. This session will present the mechanisms by which muscle mass is lost after ACL injury and evidence in support of alternative exercise interventions to optimize muscle recovery after injury.

Imprudent translation of in situ and in vitro stretch protocols to the clinic has perpetuated a misconception in the literature that exposing an untrained muscle to eccentric exercise leads to injury. This session will present the evidence in support of eccentric exercise as an efficacious intervention to optimize neural activity and muscle morphology after injury. Mechanisms by which eccentric exercise facilitates recovery and how to translate these results into the clinic will be discussed.