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Volume 18, Issue 3 (2026)
Iran J War Public Health 2026, 18(3): 1001-1027 |
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Received: 2026/08/29 | Accepted: 2026/09/18 | Published: 2026/06/20
Received: 2026/08/29 | Accepted: 2026/09/18 | Published: 2026/06/20
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Foroughi M, Jafarnezhadgero A, Rezayat H. Changes in Landing Biomechanics and Neuromuscular Control Following Anterior Cruciate Ligament Reconstruction: A Systematic Review. Iran J War Public Health 2026; 18 (3) :1001-1027
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Abstract (176 Views)
Purpose: Anterior cruciate ligament (ACL) injury is a common severe sports injury. Even after surgical reconstruction, many athletes continue to exhibit high-risk movement patterns that increase reinjury risk and early osteoarthritis. This systematic review examined changes in landing biomechanics and neuromuscular control post‑ACL reconstruction, comparing these to healthy controls and assessed corrective interventions.
Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Google Scholar, and Persian databases up to May 2026. The protocol was registered in PROSPERO (CRD420261410856). Included studies evaluated kinematic, kinetic, or electromyographic variables during landing, jumping, running, or cutting in ACL‑reconstructed individuals. Quality was assessed using the Downs and Black checklist, and findings were narratively synthesized.
Results: From 757 records, 35 eligible studies (289 subjects, predominantly young males 22–28 years) were included. ACL‑reconstructed individuals showed higher‑risk landing patterns than controls, characterized by decreased knee flexion (P=0.008), increased dynamic knee valgus (P=0.05), and greater tibiofemoral rotation (P=0.038). Sand‑based training (8 weeks, 3×/week) enhanced knee muscle co‑contraction during loading response and reduced mediolateral co‑contraction during push‑off (P<0.05). Anti‑pronation insoles reduced peak plantar pressure in metatarsal regions (P=0.010–0.044) and modulated EMG frequency. Study quality was moderate‑to‑good (scores 10–23/27). Blinding lack, small sample sizes, and absent long‑term follow‑up were key limitations.
Conclusion: ACL reconstruction is linked to persistent biomechanical and neuromuscular alterations predisposing to high‑risk movements. Surface‑based training and orthotic modifications may modulate some indicators. However, given heterogeneity, male‑dominated samples, and lack of clinical outcomes, definitive conclusions need randomized controlled trials with long‑term follow‑up.
Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Google Scholar, and Persian databases up to May 2026. The protocol was registered in PROSPERO (CRD420261410856). Included studies evaluated kinematic, kinetic, or electromyographic variables during landing, jumping, running, or cutting in ACL‑reconstructed individuals. Quality was assessed using the Downs and Black checklist, and findings were narratively synthesized.
Results: From 757 records, 35 eligible studies (289 subjects, predominantly young males 22–28 years) were included. ACL‑reconstructed individuals showed higher‑risk landing patterns than controls, characterized by decreased knee flexion (P=0.008), increased dynamic knee valgus (P=0.05), and greater tibiofemoral rotation (P=0.038). Sand‑based training (8 weeks, 3×/week) enhanced knee muscle co‑contraction during loading response and reduced mediolateral co‑contraction during push‑off (P<0.05). Anti‑pronation insoles reduced peak plantar pressure in metatarsal regions (P=0.010–0.044) and modulated EMG frequency. Study quality was moderate‑to‑good (scores 10–23/27). Blinding lack, small sample sizes, and absent long‑term follow‑up were key limitations.
Conclusion: ACL reconstruction is linked to persistent biomechanical and neuromuscular alterations predisposing to high‑risk movements. Surface‑based training and orthotic modifications may modulate some indicators. However, given heterogeneity, male‑dominated samples, and lack of clinical outcomes, definitive conclusions need randomized controlled trials with long‑term follow‑up.
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