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Background: There is limited research investigating the importance of balancing psychological readiness and physical performance when assessing if a patient is appropriate to discharge and safely return to sport. Case Description: The patient was a 21-year-old male high level athlete status post ACL reconstruction with patellar tendon graft. Treatment Plan: Treatment consisted of frequent patient education and therapeutic exercise to address an imbalance between psychological and physical readiness to return to sport. Outcomes: The patient was seen for a total of 14 visits before receiving clearance from surgeon and feeling psychologically ready to return to sport, however, he continued to receive treatment to address physical deficits. The outcome measures utilized to assess progress were primarily isokinetic strength testing and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. By 26 weeks, he achieved a 96% ACL-RSI score and a 70% quadricep ratio. Discussion: This case report describes the clinical decision making and intervention strategies utilized when physical and psychological readiness don’t align, for the patient to make a safe return to sport with goals of preventing second injury. The patient has returned to sport with no fear of reinjury and adequate lower extremity strength, suggesting the importance of utilizing a holistic treatment approach when rehabilitating a patient post ACL reconstruction.