Think Outside the Block: Rehabilitation Continuum After ACL Reconstruction with Adaptive Macro-Blocks—A Narrative Review

<b>Background:</b> Conventional rehabilitation after anterior cruciate ligament reconstruction often follows a rigid, phase-based model. This structure may overlook individual differences in healing, neuromuscular control, and psychological readiness, leading to low return-to-sport rates and a high risk of reinjury. <b>Methods:</b> This narrative review proposes a flexible rehabilitation framework based on overlapping progression blocks. Inspired by principles of strength and conditioning, motor learning, and cognitive training, this model emphasizes continuous, individualized development instead of fixed timelines. <b>Results:</b> The proposed model integrates essential components-such as joint mobility, muscle activation, motor control, and psychological factors-throughout the entire recovery process. Functional testing is redefined as a dynamic and ongoing diagnostic tool that helps clinicians identify areas needing further development, rather than acting as a simple pass/fail gateway. Progression is guided by demonstrated readiness rather than time or phase completion. <b>Conclusions:</b> Rehabilitation using adaptive, overlapping progression blocks offers a more holistic and responsive approach. It allows for better personalization, supports safer decision-making, and improves the transition back to sport through sustained development of physical and cognitive capacities.