Functional rehabilitation strategies for enhancing neuromuscular control after ACL reconstruction: A systematic review.
Minbong Kang, Byoungha Hwang, Hankyu Park
PMID 42688795WHAT IT FOUND
Nine small trials suggest jump training and aquatic exercises improve muscle coordination after ACL surgery, and blood flow restriction may protect early strength.
Most findings rest on a single trial, so treat these as promising, not proven.
Key findings
01An 8-week postoperative jump training programme produced approximately a 50% decrease in the quadriceps–hamstring co-contraction index during landing, and the improvement was maintained at follow-up.
02Preoperative blood flow restriction (BFRT) preconditioning preserved quadriceps endurance and increased RMS EMG amplitude at 4 weeks post-surgery, whereas postoperative high-load BFRT added no neuromuscular benefit beyond conventional strengthening.
03Postoperative aquatic proprioceptive training, combined with accelerated land-based rehabilitation, significantly improved activation similarity and sensorimotor output compared with land-based rehabilitation alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only nine RCTs were included, and most intervention categories (jump training, aquatic training, cross-education, sand-based training) are supported by a single trial, so no finding is replicated. Heterogeneity in EMG acquisition, normalisation, task conditions, and intervention dosing made meta-analysis impossible; results are a narrative synthesis, not a pooled estimate. Several trials had unclear randomisation and allocation concealment, and participant/personnel blinding was frequently not feasible, introducing performance bias into both EMG and functional-task outcomes. Surface EMG was the primary measure in most studies, so claims about central neural mechanisms are speculative. Studies were conducted in a limited number of countries (United States, Iran, and others), and with fewer than 10 trials, formal publication-bias assessment was not possible. The review was not prospectively registered (e.g., PROSPERO), although eligibility criteria and outcomes were defined a priori.
Declared interests
The authors declare no conflicts of interest and state the research received no specific grant from any public, commercial, or not-for-profit funding agency.
The easy way to misread this
Do not read the 50% co-contraction reduction or the BFRT endurance preservation as established, replicable effects. Each comes from a single small trial with unclear randomisation and no blinding of participants, and the review itself labels all intervention-specific conclusions as preliminary. The EMG improvements are surrogate markers; no trial in this review demonstrated a reduction in reinjury, a faster return to sport, or a change in patient-reported outcomes.