Introduction: Injuries to the anterior cruciate ligament are one of the most common knee injuries. Reconstruction is often necessary and can lead to long term cosequences such as degeneration and instability of the knee joint, graft failure and reduced quadriceps strength. An additional option to standard rehabilitation is cross-education exercise, in which planned unilateral training of the unaffected limb improves muscle performance of the injured or untrained side. Purpose: The aim of this thesis is to review the literature to investigate the effect of unilateral training of the unaffected lower limb on quadriceps muscle strength of the contralateral limb after anterior cruciate ligament reconstruction. Methods: Literature search was conducted in November and December 2022 in established databases PubMed and Cochrane Library. Results: After a detailed examination of the studies, four randomized controlled trials were included in the literature review. The were 177 patients total and all had unilateral arthroscopic ACL reconstruciton. The control groups received standard rehabilitation program and the experimental groups cross-education exercise with standard rehabilitation program. Three studies included in the literature review found that cross-education based concentric or eccentric exercise after anterior cruciate ligament reconstruction resulted in a smaller deficit of quadriceps strength or an improvement in quadriceps strength compared to the groups that underwent only standard treatment. One of the studies found that cross-education based concentric exercise did not contribute to improved muscle strength. Discussion and conclusion: Based on the literature review, we cannot definitively determine whether cross-education exercise is a meaningful addition to standard treatment. However it is beneficial to implement cross-education exercise in early stages of rehabilitation when it is contraindicated to activate or load the injured limb.
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