Cross-education improves quadriceps strength recovery after ACL reconstruction: a randomized controlled trial


KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, vol.27, no.1, pp.68-75, 2019 (SCI-Expanded) identifier identifier identifier


PurposeThe aim of this study was to investigate the effects of concentric and eccentric cross-education (CE) on quadriceps strength and knee function recoveries after anterior cruciate ligament (ACL) reconstruction.MethodsForty-eight patients (age: 29.56.8 years, body mass index: 26.13.2kg/m(2)) who had undergone ACL reconstruction with hamstring tendon autograft were included in the study. The patients were randomly divided into three groups when they reached four weeks post surgery: (1) concentric CE (n=16); (2) eccentric CE (n=16); and (3) control (n=16). All groups followed the same post-surgical rehabilitation program for their reconstructed limb. Additionally, the two experimental groups followed eight weeks of isokinetic training for the uninjured knee at 60 degrees/s for 3 days per week. Quadriceps maximum voluntary isometric strength (MVIC) was measured during the 4th week (pre-training), 12th week (post training), and 24th week post surgery. The single-leg hop distance and International Knee Documentary Committee (IKDC) scores were also evaluated during the 24th week post surgery. Analysis of variance was used for statistical analysis.ResultsGroup-by-time interaction was significant for quadriceps MVICs for reconstructed and healthy limbs (p=0.02). Quadriceps strength of both knees was greater in concentric and eccentric CE groups compared to control group during the 12th- and 24th weeks post surgery (p<0.05). Strength gain was 28% and 31% in concentric and eccentric CE groups, respectively, when compared with the control group. Concentric and eccentric CE had similar effects on quadriceps strength recovery (n.s.). IKDC score, and single-leg hop distances were not significantly different among groups (n.s.).Conclusions p id=Par4 Concentric and eccentric quadricep strengthening of healthy limbs in early phases of ACL rehabilitation improved post-surgical quadriceps strength recovery of the reconstructed limb. CE should be integrated into ACL reconstruction rehabilitation, especially in the early rehabilitative phases to restore quadriceps strength.Level of evidence p id=Par5 Randomized controlled trial, Level I.