Cross-Training Effect on Quadriceps Strength and Functional Recovery after ACL Reconstruction: A Prospective, Randomized, Controlled Study
ESSKA Academy. HARPUT G. May 11, 2018; 218191; FP52-670
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Objectives: The aim of this study was to investigate the effects of different types of cross-training effect on recovery after anterior cruciate ligament (ACL) reconstruction to determine if contralateral limb strengthening produce cross-over benefit for reconstructed limb in terms of quadriceps strength and knee function improvement.

Methods: Forty-eight patients (Age:29.48±6.85 years, BMI:26.10±3.20 kg/m2) who had undergone ACL reconstruction with hamstring tendon autograft were included in the study. The patients were randomly divided into 3 groups when they reached 1st month post-surgery: Cross-concentric training (CCT) group (n=16), Cross-eccentric training (CET) group (n=16) and control group (n=16). All groups followed the same rehabilitation program for their reconstructed limb. Additionally, the two experimental groups followed 8 weeks of isokinetic training on the uninjured knee at 60°/s; 3 days a week. Quadriceps maximum isometric strength of the groups was tested at 1st (pre-training), 3rd (post-training) and 6th months after surgery. Concentric and eccentric quadriceps strength, single leg hop test and International Knee Documentary Committee (IKDC) score were also measured at 6th months after surgery. Analysis of variance was used for statistical analysis.

Results: Group by time interaction was significant for isometric quadriceps strength for reconstructed (F(4,90)=3.15, p=0.018) and healthy knees (F(4,90)=3.04, p=0.021). Quadriceps strength of both knees was greater in CCT and CET groups compared to control group at 3rd and 6th months after surgery (p<0.05). Concentric and eccentric quadriceps strength of the knees was also greater in experimental groups compared to control group (p< 0.05). However, there was no difference between CCT and CET groups in terms of quadriceps strength (p >0.05).IKDC score and single leg hop distance were not significantly different among groups (p>0.05).

Conclusions: The findings suggest that contralateral limb quadriceps strengthening in early phase of ACL rehabilitation could help to improve quadriceps strength of the reconstructed limb following surgery. Therefore, it should be the integral part of the ACL rehabilitation protocols since quadriceps strength weakness is the main problem after ACL reconstruction. CCT and CET seem similar cross-over effect on reconstructed limb but combining different types of contraction may result in greater strength gains.

Contralateral training, cross-education, anterior cruciate ligament, quadriceps strength, rehabilitation
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