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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The 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.

Methods

Forty-eight patients (age: 29.5 ± 6.8 years, body mass index: 26.1 ± 3.2 kg/m2) 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°/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.

Results

Group-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

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

Randomized controlled trial, Level I.

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Funding

No external source of funding was used.

Author information

Authors and Affiliations

  1. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, 06100, Ankara, Turkey

    Gulcan Harput, Taha Ibrahim Yildiz, Serdar Demirci, Leyla Eraslan & Volga Bayrakci Tunay

  2. Department of Physiotherapy and Rehabilitation, Karatekin University, Çankırı, Turkey

    Burak Ulusoy

  3. Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Egemen Turhan

Authors
  1. Gulcan Harput
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  2. Burak Ulusoy
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  3. Taha Ibrahim Yildiz
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  5. Leyla Eraslan
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Correspondence to Gulcan Harput.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by Hacettepe University Institutional Review Board (KA/17157).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Harput, G., Ulusoy, B., Yildiz, T.I. et al. Cross-education improves quadriceps strength recovery after ACL reconstruction: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 27, 68–75 (2019). https://doi.org/10.1007/s00167-018-5040-1

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  • DOI: https://doi.org/10.1007/s00167-018-5040-1

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