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Neuromuscular training optimises knee function after arthroscopic ACL reconstruction.

Summary of: Risberg M, Holm I, Myklebust G, Engebretsen L (2007) Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial. Physical Therapy 87: 737-750. [Prepared by Julia Hush, CAP Editor.]


ACL injuries are common with an annual incidence of about 1 per 1000 inhabitants aged 10 to 64 years (Frobell 2007). Training is normally included in the treatment after injury or reconstruction of the ACL.

Previously, training programs focused mainly on restoration of muscle strength. In the 1990s, the sensory function of ligaments in relation to functional joint stability was recognised as important in training (Johansson 1991). Therefore, training programs including exercises that facilitate compensatory functional joint stabilisation have been advocated. However, there is a lack of studies evaluating the effects of neuromuscular training compared with more traditional training programs (Risberg 2004).

In this well-conducted RCT, the neuromuscular training (NT) group perceived better knee function compared with the traditional strength training (ST) group. However, there were no differences between the groups in observed knee function (hop tests, knee muscle strength, balance, proprioception). There were some similarities between the training programs, which may explain the few and small differences between the groups. The ST group performed mainly strengthening exercises for the lower extremity muscles, but also exercises that are included in neuromuscular training, such as core stability, balance, and functional exercises, where the quality of the performance of movements is emphasised (eg, accurate position of the knee in relation to adjacent joints). Another reason may be that too few patients were included to detect differences between groups. An interesting finding is that the ST group did not achieve better muscle strength than the NT group. This has also been reported by others (Zatterstrom 1992). Thus, training isolated muscles selectively may not be needed.

This study gives further support to the use of neuromuscular training after ACL injury.


Frobell RB et al (2007) Scand J Med Sci Sports 17: 109-114.

Johansson H et al (1991) Crit Rev Biomed Eng 18: 341-368.

Risberg M et al (2004) Phys Ther Sport 5: 125-145.

Zatterstrom R et al (1992) Scand J Rehab Med 24: 91-97.

Eva Ageberg

Lund University, Sweden
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Title Annotation:Appraisal: Critically Appraised Papers
Author:Hush, Julia
Publication:Australian Journal of Physiotherapy
Geographic Code:4EUSW
Date:Dec 1, 2007
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