Beyond the Scalpel: Nonsurgical Recovery of Neurological, Biomechanical, and Psychological Criteria After Second ACL Rupture – A Longitudinal Case

BACKGROUND: The coper classification system can be used after anterior cruciate ligament (ACL) injury to identify those who may benefit from conservative care. However, limited data exists to identify copers after a second ACL injury. This case comprehensively describes the nonsurgical recovery of a soccer athlete after graft failure. CASE PRESENTATION: A 23-year-old female ([B.K.] 57.6 kg, 1.65 m, Tegner 7) experienced a noncontact graft failure while playing soccer 9 years after her primary ACL reconstruction. OUTCOME AND FOLLOW UP: B.K. underwent intensive virtual sports rehabilitation and improved beyond clinical thresholds in most functional, muscle strength, and patient-reported outcomes. The most pronounced deficit was visual-cogntive reactive triple-hop performance demonstrating a performance cost of –20% at return to activity. DISCUSSION: Coper classification may inform the management of a second ACL injury. Future research should aim to incorporate evaluations for psychological readiness and dual-task assessments. JOSPT Cases 2025;5(2):85-93. Epub 24 April 2025. doi:10.2519/josptcases.2025.0103