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Effects of Early Progressive Eccentric Exercise on Muscle Size and Function After Anterior Cruciate Ligament Reconstruction: A 1-Year Follow-up Study of a Randomized Clinical Trial

JP Gerber, PT, PhD, SCS, ATC, is Director, US Military–Baylor University Postgraduate Sports Medicine Residency Program, US Military Academy, Keller Army Community Hospital, West Point, NY 10996 (USA)
RL Marcus, PT, PhD, OCS, is Associate Professor, Department of Physical Therapy and Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
LE Dibble, PT, PhD, ATC, is Associate Professor, Department of Physical Therapy and Department of Exercise and Sport Science, University of Utah
PE Greis, MD, is Associate Professor of Orthopedic Surgery, Department of Orthopedics, University of Utah
RT Burks, MD, is Associate Professor of Orthopedic Surgery, Department of Orthopedics, University of Utah
PC LaStayo, PT, PhD, is Associate Professor, Department of Physical Therapy, Department of Exercise and Sport Science, and Department of Orthopedics, University of Utah

Address all correspondence to Dr Gerber at: John.Gerber{at}us.army.mil

Background and Purpose: The authors previously reported that focused eccentric resistance training during the first 15 weeks following anterior cruciate ligament reconstruction (ACL-R) induced greater short-term increases in muscle volume, strength, and measures of function relative to standard rehabilitation. The purpose of this study was to evaluate the effects of early progressive eccentric exercise on muscle volume and function at 1 year after ACL-R.

Participants and Methods: Forty patients who had undergone an ACL-R were randomly assigned to 1 of 2 groups: a group that received early progressive eccentric exercise (n=20) and a group that received standard rehabilitation (n=20). Seventeen participants in the eccentric exercise group and 15 participants in the standard rehabilitation group completed a 1-year follow-up. Magnetic resonance images of the thighs were acquired 1 year after ACL-R and compared with images acquired 3 weeks after surgery. Likewise, routine knee examinations, self-report assessments, and strength and functional testing were completed 1 year after surgery and compared with previous evaluations. A 2-factor analysis of variance for repeated measures (group x time) was used to analyze the data.

Results: Compared with the standard rehabilitation group, improvements in quadriceps femoris and gluteus maximus muscle volume in the involved lower extremity from 3 weeks to 1 year following ACL-R were significantly greater in the eccentric exercise group. Improvements in quadriceps femoris and gluteus maximus muscle volume were 23.3% (SD=14.1%) and 20.6% (SD=12.9%), respectively, in the eccentric exercise group and 13.4% (SD=10.3%) and 11.6% (SD=10.4%), respectively, in the standard rehabilitation group. Improvements in quadriceps femoris muscle strength and hopping distance also were significantly greater in the eccentric exercise group 1 year postsurgery.

Discussion and Conclusions: A 12-week focused eccentric resistance training program, implemented 3 weeks after ACL-R, resulted in greater increases in quadriceps femoris and gluteus maximus muscle volume and function compared with standard rehabilitation at 1 year following ACL-R.

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