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      Thank you for the opportunity to respond to this letter. We appreciate and are sensitive to the concerns of the patient expressed in her letter. We also share her interest in avoiding the complication described in our case report in the future. We apologize that we mischaracterized her outcome to note that “she had returned to full activities” and appreciate that she has taken the time and effort to point that out. In fact, we have recently initiated a formal evaluation of functional and strength testing after ACL reconstruction at our university, and this patient showed major quadriceps deficits when she was tested (after the article was published). Interestingly, the majority of patients we have tested so far have also shown quadriceps deficits, and we are becoming increasingly aware that this should be an area of increased focus in rehabilitation after ACL reconstruction. This patient's rehabilitation has been slowed by delayed union necessitating prolonged weight-bearing precautions and pain, but she continues to work on quadriceps strengthening, and it is our sincere hope that she will indeed return to full activities in the near future.

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