Integrated physical, cognitive and psychological rehabilitation following multiple ACL reconstructions in a professional handball player: a case report

BACKGROUND: Anterior cruciate ligament (ACL) injuries with repeated surgical interventions and postoperative complications pose a major challenge in sports rehabilitation. Beyond neuromuscular deficits, psychological and cognitive readiness often remain impaired, increasing reinjury risk and threatening athletic careers. This case highlights an integrated rehabilitation strategy addressing physical, psychological, and cognitive domains in a professional athlete with a complex surgical history. CASE PRESENTATION: A 31-year-old white Serbian male professional handball player with a history of two ACL reconstructions, meniscal repairs, a postoperative knee infection, and multiple arthroscopic interventions presented with persistent knee instability, pain, and psychological distress. Following repeated failed return-to-play attempts, he underwent a ten-week intervention combining therapeutic exercises, sports psychology sessions, and neurocognitive dual-task training. Pre- and post-intervention assessments included gait analysis, postural control, strength testing, ACL-specific functional tests, and psychological evaluations. Post-intervention assessments showed improvements in gait mechanics, postural stability, neuromuscular strength, and reduced functional asymmetries, alongside lower cognitive anxiety and greater motivation. CONCLUSIONS: This case suggests that an interdisciplinary, multimodal rehabilitation approach, integrating physical, psychological, and cognitive strategies, may help address both physical deficits and psychological barriers in athletes with multiple ACL surgeries and complex postoperative courses. Such integration may support function, confidence, and readiness in high-performance athletes facing career-threatening injuries.