Cross-education does not accelerate the rehabilitation of neuromuscular functions after ACL reconstruction: A randomized controlled clinical trial

Zult, T., Gokeler, A., van Raay, J. J. A. M., Brouwer, R. W., Zijdewind, I., Farthing, J. P. & Hortobagyi, T., Aug-2018, In : European Journal of Applied Physiology. 118, 8, p. 1609-1623 15 p.

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Cross-education reduces quadriceps weakness 8 weeks after anterior cruciate ligament (ACL) surgery, but the long-term effects are unknown. We investigated whether cross-education, as an adjuvant to the standard rehabilitation, would accelerate recovery of quadriceps strength and neuromuscular function up to 26 weeks post-surgery.

Group allocation was randomized. The experimental (n = 22) and control (n = 21) group received standard rehabilitation. In addition, the experimental group strength trained the quadriceps of the non-injured leg in weeks 1-12 post-surgery (i.e., cross-education). Primary and secondary outcomes were measured in both legs 29 +/- 23 days prior to surgery and at 5, 12, and 26 weeks post-surgery.

The primary outcome showed time and cross-education effects. Maximal quadriceps strength in the reconstructed leg decreased 35% and 12% at, respectively, 5 and 12 weeks post-surgery and improved 11% at 26 weeks post-surgery, where strength of the non-injured leg showed a gradual increase post-surgery up to 14% (all p ae 0.015). Limb symmetry deteriorated 9-10% more for the experimental than control group at 5 and 12 weeks post-surgery (both p ae 0.030). One of 34 secondary outcomes revealed a cross-education effect: Voluntary quadriceps activation of the reconstructed leg was 6% reduced for the experimental vs. control group at 12 weeks post-surgery (p = 0.023). Both legs improved force control (22-34%) and dynamic balance (6-7%) at 26 weeks post-surgery (all p ae 0.043). Knee joint proprioception and static balance remained unchanged.

Standard rehabilitation improved maximal quadriceps strength, force control, and dynamic balance in both legs relative to pre-surgery but adding cross-education did not accelerate recovery following ACL reconstruction.

Original languageEnglish
Pages (from-to)1609-1623
Number of pages15
JournalEuropean Journal of Applied Physiology
Issue number8
Publication statusPublished - Aug-2018


  • Force control, Maximal voluntary force, Postural stability, Proprioception, Strength training, Twitch interpolation, ANTERIOR CRUCIATE LIGAMENT, EXCURSION BALANCE TEST, QUADRICEPS ACTIVATION, MUSCLE STRENGTH, KNEE INJURIES, RETURN, FORCE, SYSTEM, SPORT, RELIABILITY

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