Functional and Neuroplastic Effects of Cross-Education in Anterior Cruciate Ligament Rehabilitation: A Scoping Review with Bibliometric Analysis
Source abstract
Abstract
Anterior cruciate ligament reconstruction (ACLR) results in prolonged muscle weakness, impaired neuromuscular control, and delayed return to sport. Cross-education (CE), unilateral training of the uninjured limb, has been proposed as an adjunct therapy to promote bilateral adaptations. This scoping review evaluated the functional and neuroplastic effects of CE rehabilitation post-ACLR. Following PRISMA-ScR and JBI guidelines, PubMed, Scopus, Web of Science, and PEDro were searched up to February 2025. A bibliometric analysis was also conducted to report keyword co-occurrence and identify trends in this line of research. Of 333 screened references, 14 studies (price index: 43% and low-to-moderate risk of bias) involving 721 participants (aged 17–45 years) met inclusion criteria. CE protocols (6–12 weeks; 2–5 sessions/week) incorporating isometric, concentric, and eccentric exercises demonstrated strength gains (10–31%) and strength preservation, alongside improved limb symmetry (5–14%) and dynamic balance (7–18%). There is growing interest in neuroplasticity and corticospinal excitability, although neuroplastic changes were assessed heterogeneously across studies. Findings support CE as a feasible and low-cost strategy to complement early-stage ACLR rehabilitation, especially when direct loading of the affected limb is limited. Standardized protocols for clinical intervention and neurophysiological assessment are needed.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Knee injuries and reconstruction techniques · Sports injuries and prevention · Muscle activation and electromyography studies
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
ARTHROS Centro de Fisioterapia y Ejercicio, Medellín 050033, Colombia
Research Group of Applied Sciences to Physical Activity and Sport, Universidad de Antioquia, Medellín 050010, Colombia
Practices and Knowledge in Latin America, Universidad Nacional de Colombia, Medellín 050034, Colombia
Educational and Pedagogical Studies and Research Group (GEIEP), Corporación Universitaria Minuto de Dios, Medellín 050034, Colombia
Facultad de Medicina, Universidad San Pablo-CEU, Campus Monteprincipe, 28668 Boadilla del Monte, Spain
Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, Universidad de Valencia, 46010 Valencia, Spain
Galascreen Laboratories, Department of Pharmacy, Health, and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
Grupo de Investigación NUTRAL, Facultad Ciencias de la Nutrición y los Alimentos, Universidad CES, Medellín 050021, Colombia
Funding
European DBSS Research Division
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Show source-provided references
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