Innovative rehabilitation strategies for optimizing recovery and preventing re-injury following ACL reconstruction among athletes in University of Calabar Teaching Hospital (UCTH): a prospective mixed-methods quasi-experimental study

Background Anterior cruciate ligament (ACL) injuries are common among athletes and are associated with prolonged absence from sport, functional limitations, and high re-injury risk. This prospective study evaluated the effectiveness of a 12-week innovative rehabilitation program on functional recovery, muscle strength, range of motion (ROM), adherence, and psychological readiness among athletes following ACL reconstruction at the University of Calabar Teaching Hospital.Methods A prospective mixed-methods quasi-experimental design was employed. Quantitatively, 80 athletes who had undergone arthroscopically assisted unilateral ACL reconstruction using autograft techniques completed pre- and post-intervention assessments and a priori power analysis determined a minimum sample size of 72 (α = 0.05, power = 0.80); 80 participants were recruited. Qualitatively, three focus group discussions (n = 12). Quantitative data were analysed using descriptive statistics, Pearson correlation, and multiple regression analyses, while thematic analysis was applied to qualitative data.Results Significant improvements were observed in IKDC scores (p < 0.001; +60%), Lysholm scores (p < 0.001; +49%), quadriceps strength (p < 0.001; +45%), hamstring strength (p < 0.001; +43%), and knee flexion ROM (p = 0.006; +20°). Quadriceps strength, hamstring strength, ROM, adherence, and psychological readiness explained 72% of the variance in functional recovery (R2 = 0.72, p < 0.001). Re-injury incidence was 6.3%, with 97.5% returning to sport within 12 months. Qualitative findings highlighted perceived effectiveness, motivation, psychological readiness, and rehabilitation challenges.Conclusion The innovative rehabilitation program was associated with significant physical, psychological, and functional improvements and reduced re-injury risk among young athletic populations following ACL reconstruction.