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A. Kainth1, P. Kuithan1
1Coventry University, Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health-Physiotherapy, Coventry, United Kingdom
Background: Individuals following an Anterior Cruciate Ligament Reconstruction (ACLR) often present with evident quadriceps strength deficits which can ultimately impact on levels of function and readiness to return to sport. Clinical benefits of cross-education (CE) training on inducing strength gains in the contra-lateral, untrained limb have been shown. CE training could be beneficial to optimise quadriceps strength and function during the rehabilitation process following an ACLR via exercising the uninjured limb.
Purpose: To synthesise and critically evaluate the effectiveness of CE training on firstly quadriceps function and secondly patient-reported functional outcomes for individuals following an ACLR.
Methods: A systematised literature review and narrative synthesis of randomised controlled trials was performed. Four electronic databases (Medline, CINAHL, AMED and SPORTDiscus) along with supplementary searches were searched in June 2022. Eligibility criteria comprised of participants who had undergone an ACLR irrespective of gender, activity levels, or the graft type utilised. Additionally, studies with a CE training intervention group exercising the uninjured limb were included. This intervention group compared against a control group performing standard ACLR rehabilitation.
The effect of CE training on quadriceps function was determined as the average quadriceps strength percentage change from pre-post intervention. The quality of the included studies was assessed using the PEDro scale and CONSORT reporting guidelines. A narrative synthesis using GRADE was performed to determine the overall quality and confidence in the evidence.
The effect of CE training on quadriceps function was determined as the average quadriceps strength percentage change from pre-post intervention. The quality of the included studies was assessed using the PEDro scale and CONSORT reporting guidelines. A narrative synthesis using GRADE was performed to determine the overall quality and confidence in the evidence.
Results: Four studies with a total of 177 participants were included in the review (PEDro scale score 6-7/10). Across all studies, there was a 55% median (range -41% to +150%) quadriceps strength gain in the reconstructed limb with CE training between 5 and 26 weeks post-ACLR.
However, the control groups, showed a 32% median quadriceps strength gain (range -36% to +100%).Three out of four studies demonstrated significantly greater improvements in quadriceps function with CE training within 12 weeks post-ACLR. Confidence in cumulative evidence was downgraded due to (serious) concerns across two GRADE domains- imprecision and indirectness. There is low-quality evidence that CE training is effective at improving quadriceps function within 12 weeks post-ACLR.
For the second objective, significant improvements in patient-reported functional outcomes were observed over time within both CE training and control groups. Low-quality evidence demonstrated that CE training has no additional benefit of further improving patient-reported functional outcomes following an ACLR.
However, the control groups, showed a 32% median quadriceps strength gain (range -36% to +100%).Three out of four studies demonstrated significantly greater improvements in quadriceps function with CE training within 12 weeks post-ACLR. Confidence in cumulative evidence was downgraded due to (serious) concerns across two GRADE domains- imprecision and indirectness. There is low-quality evidence that CE training is effective at improving quadriceps function within 12 weeks post-ACLR.
For the second objective, significant improvements in patient-reported functional outcomes were observed over time within both CE training and control groups. Low-quality evidence demonstrated that CE training has no additional benefit of further improving patient-reported functional outcomes following an ACLR.
Conclusions: CE training could serve as an effective adjunct to the rehabilitation process within 12 weeks post-ACLR. However, given the small number of studies included within this review and the heterogeneity amongst them, further studies are warranted to validate these findings. Further research needs to elucidate the CE training programme parameters to optimise the cross-transfer strength effect.
Implications: Clinical practice guidelines advocate the use of progressive strength training following an ACLR, therefore incorporating CE training could optimise rehabilitation. A CE quadriceps strengthening programme appears to both attenuate the quadriceps strength loss and induce strength gains within the reconstructed limb. A greater understanding of how to manipulate training and exercise parameters is needed to design an optimal CE programme for clinical practice.
Funding acknowledgements: This work was unfunded
Keywords:
CE training
ACLR
Quadriceps strength change
CE training
ACLR
Quadriceps strength change
Topics:
Musculoskeletal: lower limb
Sport & sports injuries
Orthopaedics
Musculoskeletal: lower limb
Sport & sports injuries
Orthopaedics
Did this work require ethics approval? Yes
Institution: Coventry University
Committee: Coventry University Ethics Committee
Ethics number: P131055- project approved as low risk
All authors, affiliations and abstracts have been published as submitted.
