One Year of Rehabilitation for Less Than One Hour of Rugby: Rehabilitation, Return to Sport, and Re-Injury After ACL Reconstruction: A Longitudinal Mixed-Methods Case Report

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is common in young athletes, yet the psychological impact of re-injury is less understood. CASE PRESENTATION: We report the 12-month rehabilitation journey of an amateur female rugby player after ACL reconstruction. She completed physiotherapy, muscle function testing, and patient-reported outcome assessments, alongside serial interviews. She suffered a second ACL injury at return to sport. OUTCOME AND FOLLOW-UP: Rehabilitation was initially marked by motivation, optimism, and strong athletic identity, yet persistent insecurity about return to sport remained. At return to unrestricted training, she sustained a second non-contact ACL injury, which triggered profound emotional disruption, grief, and uncertainty. DISCUSSION: This case highlights the psychological vulnerability of athletes facing ACL re-injury, even after successful physical recovery. Clinicians should attend not only to muscle function and readiness for sport but also to emotional well-being, identity concerns, and coping strategies throughout rehabilitation and return to play.