Return-to-Play after ACL Reconstruction: A Single-Case Study of Multi-Context Biomechanical Monitoring in Collegiate Basketball

Abstract Introduction Anterior cruciate ligament (ACL) injuries represent one of the most common and disruptive conditions in sport, with fewer than two-thirds of athletes return to competitive play. Effective return-to-play (RTP) monitoring requires multidimensional approaches that capture physical, psychological, and sport-specific components rather than reliance of isolated benchmarks. Purpose This study aimed to longitudinally examine the RTP process of a female varsity basketball athlete following ACL reconstruction, using a framework that integrates physical performance (capacity), biomechanical sport-specific (capability), and psychological (confidence) components relative to pre-injury benchmarks. Methods Data collection included countermovement jump testing with dual force plates, on-court inertial measurement unit (IMU) monitoring of limb-loading, and psychological questionnaires, analyzed relative to pre-injury and post-surgery baselines using minimal detectable change thresholds. Results Pre-injury monitoring indicated stable movement profiles with only minor fluctuations. Following ACL reconstruction, jump height recovered within seven weeks of RTP initiation, but notable inter-limb asymmetries persisted in force plate and IMU measures despite high confidence scores. Discussion Symmetry improved with continued training, yet variability in on-court loading remained even after clinical clearance. These findings highlight the value of integrated, multidimensional monitoring to detect residual deficits that may be overlooked by traditional outcome-based assessments. Conclusion This study demonstrates that integrating athlete-specific biomechanical, psychological, and sport-specific assessments relative to pre-injury baselines can support RTP decision-making to enhance individualized recovery trajectories in female athletes.