2025, Vol. 12, Issue 5, Part I

Background: Anterior Cruciate Ligament (ACL) injuries pose significant physical and psychological challenges during postoperative recovery, particularly among active individuals. Standard rehabilitation often focuses on physical recovery, but psychological barriers like anxiety and fear of re-injury can impede progress. This case report presents a multimodal rehabilitation approach integrating blood flow restriction therapy, neuromuscular electrical stimulation (NMES), and Cognitive Behavioral Therapy (CBT) in a female following ACL reconstruction.

Case Presentation: A 42-year-old female presented with a chronic history of right knee instability culminating in a high-grade ACL tear and medial meniscus injury. Post-arthroscopic reconstruction, she reported severe pain (NPRS 8–9/10), limited knee mobility (active ROM 0–15°), quadriceps weakness (grade 2+), and moderate anxiety (BAI 25). Her rehabilitation included progressive exercise therapy based on Kisner & Colby framework, Blood Flow Restriction (BFR) therapy, NMES, and structured CBT to address psychological concerns.

Intervention & Outcome: Over six weeks, the patient demonstrated consistent improvements: NPRS reduced to 3/10, active knee flexion increased to 0–115°, quadriceps strength reached grade 3+, and BAI score dropped to 20. CBT techniques—including cognitive restructuring, graded exposure, and behavioural activation—effectively reduced anxiety and enhanced rehabilitation adherence. The patient successfully returned to dance-related activities.

Conclusion: A comprehensive, multimodal rehabilitation protocol combining physical and psychological interventions facilitated significant improvements in pain, strength, mobility, and anxiety. This approach supports the integration of mental health strategies within physical rehabilitation for optimal recovery after ACL reconstruction.