en تروما Trauma سردبیری Editorial <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times="">Abstract</span></span></b></span></span><br> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times=""><span style="color:#0f1115">Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure, yet individuals post-ACLR face a significantly elevated risk of developing post-traumatic osteoarthritis (PTOA), exceeding 50% within 10&ndash;15 years. This narrative synthesis interprets current evidence and clinical viewpoints to highlight modifiable risk factors influencing long-term outcomes and proposes actionable strategies for joint preservation. This perspective utilizes a narrative synthesis approach to interpret the existing literature. The search strategy involved utilizing keywords, such as &quot;anterior cruciate ligament reconstruction,&quot; &quot;post-traumatic osteoarthritis,&quot; &quot;rehabilitation,&quot; and &quot;modifiable risk factors&quot; across databases, including PubMed and Scopus, to inform the presented synthesis spanning recent years.<b> </b>Key modifiable risk factors are categorized into pre-operative and post-operative phases. Pre-operatively, factors, such as quadriceps weakness, loss of full extension, aberrant movement patterns, joint effusion, and low psychological readiness, are critical targets. Post-operatively, persistent strength deficits, poor movement quality, inadequate load management, and elevated body mass index are associated with increased PTOA risk. Evidence-based strategies, such as pre-habilitation, criterion-based rehabilitation, neuromuscular training, and lifelong maintenance programs, demonstrate a relationship with risk mitigation.<b> </b>The high prevalence of PTOA following ACLR is not inevitable. By systematically addressing modifiable risk factors through targeted, objective, and sustained interventions, clinicians can significantly improve long-term joint health and functional outcomes.</span></span></span></span></span><br> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times=""><span style="color:#0f1115">Keywords:</span></span></span></b><span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times=""><span style="color:#0f1115"> Anterior cruciate ligament, Osteoarthritis, Reconstruction, Rehabilitation</span></span></span></span></span><br> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"></span></span></b></span></span> Anterior cruciate ligament, Osteoarthritis, Reconstruction, Rehabilitation 0 0 http://jsurgery.bums.ac.ir/browse.php?a_code=A-10-539-1&slc_lang=en&sid=1 Ebrahim Piri ebrahimm.piri@gmail.com 100319475328460012581 100319475328460012581 No Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden. AmirAli Jafarnezhadgero amiralijafarnezhad@gmail.com 100319475328460012582 100319475328460012582 Yes Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran Mahdieh Foroughi mailto:mahdiyehforoughi@student.uma.ac.ir 100319475328460012583 0009-0002-9163-6268 No Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran