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March 15, 2026Journal of Orthopaedic Surgery and Research2 citationsOpen Access

Cross-education effects of healthy-side lower-limb strength training on neuromuscular function recovery following anterior cruciate ligament reconstruction: a randomized controlled trial

CLChao LiuZSZihao SunXJXiangZhan Jiang

Key Points

  • The research investigates the effect of Healthy-Side Lower-Limb Strength Training on neuromuscular recovery following ACL reconstruction.
  • Single-masked randomized controlled trial with 40 ACLR patients, divided into intervention and control groups.
  • Intervention group received strength training in addition to standard rehab for 6 weeks; control group received standard rehab only.
  • Knee function assessed using Lysholm knee function score and muscle activation measured via electromyography during maximal contraction and level walking.
  • Both groups showed significant improvement in Lysholm scores post-intervention, but greater improvement was seen in the intervention group (P < 0.01).
  • Intervention group reduced limb asymmetry significantly in all muscle groups during tests (P < 0.01).
  • Activation levels of specific muscles increased significantly in the intervention group compared to control group (P < 0.05).

Abstract

Based on cross-education theory, this study aimed to investigate whether Healthy-Side Lower-Limb Strength Training could promote neuromuscular function recovery of the injured limb in patients following anterior cruciate ligament reconstruction (ACLR) through central nervous system-mediated contralateral adaptive mechanisms. A single-masked, randomized controlled trial was conducted with 40 patients at 5–6 weeks post-ACLR, who were randomly allocated to intervention and control groups (n = 20). The control group received conventional rehabilitation, while the intervention group received conventional rehabilitation plus Healthy-Side Lower-Limb Strength Training for 6 weeks. The Lysholm knee function score was used to assess knee joint function at baseline and post-intervention. A wireless surface electromyography system was used to measure root mean square (RMS) values of bilateral rectus femoris, semitendinosus, tibialis anterior, and lateral gastrocnemius muscles during maximal voluntary contraction and level walking. The activation ratios of the flexor and extensor muscle groups were calculated to evaluate muscle synergy patterns. The effects of Healthy-side strength training on bilateral lower limb muscle activation patterns and knee joint function were assessed through within-group pre- and post-intervention comparisons and between-group analyses. Following the 6-week intervention, Lysholm knee function scores improved significantly in both groups, with the intervention group demonstrating a significantly greater magnitude of improvement than the control group (P 0.05). Healthy-Side Lower-Limb Strength Training effectively promoted knee joint function recovery and enhanced bilateral lower limb muscle activation in patients following ACLR through cross-education mechanisms. These findings validate the clinical utility of cross-education theory and support Healthy-side strength training as an innovative rehabilitation strategy for early post-ACLR recovery. Chinese Clinical Trial Registry ChiCTR2400087325. Registered on 25/07/2024.

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Cite This Study

Liu et al. (2026) studied this question.

synapsesocial.com/papers/69b64d48b42794e3e660e0cfhttps://doi.org/10.1186/s13018-026-06776-6
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