Effectiveness of Unilateral Training of the Uninjured Limb on Muscle Strength and Knee Function of Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Cross-Education

Abstract

Context: Unilateral training of the uninjured limb could be a useful therapeutic tool to induce cross-education in periods of immobilization, however, the effectiveness of this training in patients with anterior cruciate ligament (ACL) reconstruction is unknown. Objective: To determine the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients with ACL reconstruction. Design: Systematic review and meta-analysis. Evidence Acquisition: An electronic search was performed in the MEDLINE, LILACS, CENTRAL, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, and PEDro databases from inception until March 2021. The authors included randomized clinical trials that evaluated the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients after ACL reconstruction. Evidence Synthesis: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. The standardized mean difference for isometric quadriceps strength was 0.60 at 8 to 12 weeks (95% confidence interval, 0.29 to 0.92; P = .01; I2 = 6%). There was a high quality of evidence according to the Grading of Recommendation, Assessment, Development and Evaluation rating. Four studies assessed knee function through different self-administered questionnaires at 8, 24, and 26 weeks. Only one study reported significant differences in knee function at 8 weeks, favoring the unilateral training group. Conclusions: There was a moderate to high quality of evidence, with statistical significance that the addition of unilateral training to standard rehabilitation improved the cross-education of quadriceps strength after ACL reconstruction. More research is needed to assess the consistency of these results. International Prospective Register of Systematic Reviews registration number: CRD42020199950.

Potential role of cross-education in early-stage rehabilitation after anterior cruciate ligament reconstruction

“…Protocols that mitigate and restore quadriceps weakness and strength post-ACLR are a critical component of rehabilitation. Cross-education may attenuate the loss in neuromuscular function during disuse (online supplemental file), serve as an adjunct intervention for increasing quadriceps strength3 and enhance neuroplasticity in pathways known to be attenuated with ACLR (online supplemental file). This commentary reviews the potential role of cross-education in rehabilitation following ACLR and offers a summary of the physiological rationale for considering this intervention during early-stage ACLR rehabilitation.SP110.1136/bjsports-2023-107456.supp1…”