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Strengthening-based rehabilitation improves knee muscle strength following ACL reconstruction but shows no effect on hop performanceStrength Training Improves Muscle Strength After ACL Reconstruction Surgery

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Key Takeaway
Note that strengthening-based rehabilitation improves knee muscle strength but does not significantly impact hop performance.

This meta-analysis synthesized data from 9 trials and 24 effect sizes to evaluate the impact of strengthening-based rehabilitation on patients following anterior cruciate ligament reconstruction (ACLR). The analysis focused on primary outcomes of knee muscle strength and secondary outcomes including hop performance.

The authors found a significant improvement in knee muscle strength with an effect size of 0.39 (Hedges' g; 95% CI 0.01–0.77, p = 0.046). In contrast, the analysis of hop performance showed no significant effect, yielding an effect size of -0.03 (Hedges' g; 95% CI -0.54 to 0.48, p = 0.906).

A notable limitation identified by the authors was the high heterogeneity in hop performance data (I2 = 77.8%). While strengthening-oriented interventions appear to improve muscle strength post-ACLR, the lack of significant change in hop performance suggests that specific components of functional movement may not be captured by general strengthening alone. Clinical application should consider these results as a summary of existing evidence rather than individual patient recommendations.

A review of nine trials involving patients who underwent anterior cruciate ligament reconstruction (ACLR) looked at how strengthening exercises affect recovery. The study focused on two main areas: the strength of the muscles in the knee and the performance of jumping movements, known as hop performance.

The data showed that patients who followed a strengthening-based rehabilitation program saw significant improvements in their knee muscle strength. However, the same group did not show a significant change in their hop performance scores. Because the study included many different types of programs, the results for hopping were less consistent across the trials.

While these findings suggest that strength training is effective for building muscle after surgery, it does not provide specific instructions for individual patients. The evidence shows a link between targeted exercise and muscle gains, but more consistency is needed to understand its impact on jumping ability. Patients should talk with their doctors or physical therapists to create a personalized recovery plan.

What this means for you:
Strength-based rehab improves knee muscle strength after ACL surgery, but results for hop performance are unclear.

Common questions

Does strength training help after ACL surgery?

Yes, the analysis of 9 trials showed that strengthening-based rehabilitation led to a significant improvement in knee muscle strength for patients who had an anterior cruciate ligament reconstruction. This suggests that focusing on strength is a helpful part of the recovery process for building muscle.

Does it improve jumping performance after ACL surgery?

The study did not find a significant effect on hop performance for patients following ACL reconstruction. Because there was high variation in how these tests were performed across different trials, the results for hopping are less certain than the results for muscle strength.

Is it safe to do strengthening exercises after surgery?

The study did not report any specific adverse events or safety concerns regarding the use of strengthening-based rehabilitation. However, you should always consult with your doctor or a physical therapist to ensure the exercises are appropriate for your specific stage of recovery.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundPersistent deficits in periarticular muscle strength and functional performance are commonly observed following anterior cruciate ligament reconstruction, potentially compromising long-term knee joint health. As a key non-pharmacologic rehabilitation strategy, strengthening exercise is widely implemented to address these impairments. However, evidence regarding its effects on knee muscle strength and hop-performance outcomes remains inconsistent. Therefore, this study aimed to systematically quantify the effects of strengthening exercise on knee muscle strength and hop performance after ACLR using a three-level meta-analytic approach.MethodsPubMed, Web of Science, Embase, Cochrane Library, and SPORTDiscus were searched through January 6, 2026. Randomized controlled trials examining strengthening-based rehabilitation after ACLR were included. Standardized mean differences (Hedges’ g) were calculated from pre–post change scores. Three-level multivariate random-effects meta-analyses were conducted, with moderator analyses examining postoperative time, population type, and assessment time point. Risk of bias was assessed using RoB 2, and publication bias was explored via funnel plots and Egger’s regression.ResultsNine trials were included, contributing a total of 24 effect sizes across outcomes. Strengthening exercise significantly improved knee muscle strength (d = 0.39, 95% CI 0.01–0.77, p = 0.046, I2 = 55.8%). No significant effect was found for hop performance (d = −0.03, 95% CI − 0.54 to 0.48, p = 0.906, I2 = 77.8%). No statistically significant moderation effects of postoperative time, population type, or assessment time point were detected for either outcome.ConclusionStrength-oriented rehabilitation interventions appear to improve knee muscle strength following ACL reconstruction, whereas no significant overall effect was observed for hop performance. Comprehensive rehabilitation strategies addressing neuromuscular and functional demands may be required to optimize postoperative recovery.
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