Strategies for optimal rehabilitation after anterior cruciate ligament (ACL) reconstruction (ACLR) continue to evolve, as the incidence of contralateral ACL injuries and ACL failures varies widely in the literature, highlighting the need for optimising rehabilitation protocols. Early and intermediate rehabilitation build the crucial foundation on which later stages of rehabilitation can successfully be based, ideally leading to satisfactory outcomes and return to preinjury sports performance. However, guidelines for optimal pre- and postoperative rehabilitation management following ACLR remain conflicting, complicating evidence-based decision-making for rehabilitation following ACLR in clinical practice. Furthermore, a standardised rehabilitation protocol, adopted across different institutions, could enable more reliable comparisons of outcomes across studies focusing on surgical aspects, such as graft selection and fixation methods. An international, multidisciplinary group of experts was convened at the 2024 Freddie Fu Panther Sports Medicine Symposium to discuss and debate recent advances and future directions of rehabilitation and return to sport following ACLR. While this part of the series explores the preoperative and early to intermediate phases of rehabilitation, Part 2 highlights the complexity of return to sport and adjunct technologies after ACLR. Early recovery of knee extension, quadriceps function and early focus on movement quality are key components for achieving satisfactory outcomes after ACLR. This summary of key concepts aims to give an overview of recent evidence and current concepts of early and intermediate rehabilitation after ACLR from a multidisciplinary expert perspective and how it needs to be tailored to the individual based on graft type and patient demographics in clinical practice. LEVEL OF EVIDENCE: Level IV, expert opinion.
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