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Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial

Abstract

Purpose

To investigate the effects of cross-education (CE) exercise on strength and performance at 10 and 24 weeks post anterior cruciate ligament (ACL) surgery.

Methods

Design: randomised controlled trial. N = 44 ACL-reconstruction patients, randomly-allocated into: CE: strength training of the non-operative limb, or CON: sham exercise of upper limb stretching. Each patient underwent standardised ACL rehabilitation, plus 8 weeks of thrice weekly CE or CON, commencing at 2 weeks post surgery. The primary outcome was quadriceps peak force (QPF) of the ACL-reconstructed limb at 10 weeks post surgery. Secondary measures were hamstrings peak force (HPF), rate of force development (RFD) and International Knee Documentation Committee score (IKDC) at 10 and 24 weeks; QPF and hop for distance (HOP) at 24 weeks post surgery.

Results

CE significantly attenuated the decline in QPF of the ACL-reconstructed limb at 10 weeks compared to CON (16.6% decrease vs. 32.0%, respectively); that advantage was not retained at 24 weeks. A training effect was observed in the trained limb for HPF and QPF, which was retained at 24 weeks. No significant differences were observed for IKDC, HOP, RFD, or HPF of the reconstructed limb. Inter-limb symmetry (ILS) ranged from 0.78 to 0.89 and was not significantly different between groups.

Conclusion

High-intensity CE strength training attenuated the post-operative decline in QPF and should be considered in early-phase ACL rehabilitation. ILS data showed good symmetry, but it masked significantly inferior performance between groups and should be used with caution.

Trial registration number

NCT02722876.

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Availability of data and material

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not Applicable.

Abbreviations

ACL:

Anterior cruciate ligament

CE:

Cross-education

CON:

Control

QPF:

Quadriceps peak force

HPF:

Hamstrings peak force

RFD:

Rate of force development

ILS:

Inter-limb symmetry

IKDC:

International knee documentation

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Funding

Funding for this trial was received from the Private Physiotherapy Education Fund, UK (PPEF), grant number: 205.

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Affiliations

Authors

Contributions

CM: Trial design; acquisition and interpretation of data; preparation of manuscript; final approval of manuscript; AB: Trial design; acquisition of data; critical review and final approval of manuscript, trial physiotherapist.PG; SR; AB: Acquisition of data; critical review of manuscript; final approval of manuscript; JHK: Trial design; statical analysis critical review and final approval of manuscript.

Corresponding author

Correspondence to Claire Minshull.

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Conflict of interest

There are no conflicts of interest to report.

Ethical approval

The study was approved by the regional NHS research ethics committee.

Consent to participate

Participants provided their written informed consent to participate in this study.

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The authors provide formal consent to publish.

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Communicated by Toshio Moritani.

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Cite this article

Minshull, C., Gallacher, P., Roberts, S. et al. Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial. Eur J Appl Physiol (2021). https://doi.org/10.1007/s00421-021-04812-3

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Keywords

  • Cross-education
  • Cross-transfer
  • Rehabilitation
  • Strength training