Benefits of strength training for high-performance athletes in anterior cruciate ligament rehabilitation
DOI:
https://doi.org/10.33448/rsd-v14i10.49704Keywords:
Anterior Cruciate Ligament (ACL), Strength training, Athletes.Abstract
This article aimed to analyze the benefits of strength training in the rehabilitation of high-performance athletes after anterior cruciate ligament (ACL) reconstruction. A literature review identified studies conducted between 2015 and 2025 that addressed resistance exercise protocols and their effects on joint function, muscle strength, and return to sport. The results indicate that quadriceps, hamstring, and gluteal deficits are common after surgery, impacting dynamic stability and athletic performance. Evidence suggests that strength training, especially eccentric, isokinetic, and functional modalities, promotes gains in hypertrophy, muscle torque, limb symmetry, and athlete confidence. Furthermore, protocols that combine closed and open kinetic chain exercises, combined with neuromuscular and plyometric stimuli, have proven more effective in reducing persistent deficits and preventing relapses. The conclusion is that progressive and well-structured strengthening is essential to accelerate functional recovery and ensure greater athletic longevity.
References
Arundale, A. J. H., Capin, J. J., Zarzycki, R., Smith, A. H., Snyder-Mackler, L., & The ACL-SPORTS Trial Team. (2017). Report of the clinical and functional primary outcomes in men of the ACL-SPORTS trial: Similar outcomes in men receiving secondary prevention with and without perturbation training 1 and 2 years after ACL reconstruction. Clinical Orthopaedics and Related Research, 475(10), 2523–2534. https://doi.org/10.1007/s11999-017-5449-7
Calvo Fernández, Y., & Lago Rodríguez, Á. (2025). Programa preventivo de lesión de ligamento cruzado anterior en fútbol femenino durante períodos de confinamiento. Revista Cubana de Ortopedia y Traumatología, 36(1). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1405524
Du, C., Liu, J., Deng, H., Ma, Y., Li, Y., Zhang, M., & Li, S. (2024). Three-month functional training programme improves knee joint function in athletes post-ACL reconstruction surgery. Journal of Rehabilitation Medicine, 56, jrm18701. https://doi.org/10.2340/jrm.v56.18701
Figueira, V. L. G., & da Silva Júnior, J. A. (2022). A importância da terapia imediata no pós-operatório do ligamento cruzado anterior. Pesquisa, Sociedade e Desenvolvimento, 11(1), e18111125192. https://doi.org/10.33448/rsd-v11i1.25192
Fitzgerald, G. K., Piva, S. R., & Irrgang, J. J. (2003). A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. Journal of Orthopaedic & Sports Physical Therapy, 33(9), 492–501. https://doi.org/10.2519/jospt.2003.33.9.492
Fleck, S. J., & Kraemer, W. J. (2017). Fundamentos do treinamento de força muscular (4ª ed.). Porto Alegre: Artmed.
Fontanier, V., Vincent, J., Tardy, N., Fritsch, S., Borel, T., & Calmels, P. (2025). Effect of open kinetic chain exercises during the first weeks of anterior cruciate ligament reconstruction rehabilitation: A systematic review and meta-analysis. Physical Therapy in Sport, 72, 95–108. https://doi.org/10.1016/j.ptsp.2025.01.004
Gerber, J. P., Marcus, R. L., Dibble, L. E., Greis, P. E., & LaStayo, P. C. (2009). 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. Physical Therapy, 89(1), 51–59. https://doi.org/10.2522/ptj.20070189
Germano Maciel, D., Santos Cerqueira, M., Gabbett, T. J., Elsangedy, H. M., & de Brito Vieira, W. H. (2022). Should we trust perceived effort for loading control and resistance exercise prescription after ACL reconstruction? Sports Health, 14(5), 764–769. https://doi.org/10.1177/19417381211041289
Greenberg, E. M., Greenberg, E. T., Albaugh, J., Storey, E., & Ganley, T. J. (2018). Rehabilitation practice patterns following anterior cruciate ligament reconstruction: A survey of physical therapists. Journal of Orthopaedic & Sports Physical Therapy, 48(10), 801–811. https://doi.org/10.2519/jospt.2018.8264
Johnson, A. K., Kuenze, C. M., Bley, J. A., Johnson, A. L., Saliba, S. A., & Hart, J. M. (2022). Functional resistance training after anterior cruciate ligament reconstruction improves knee angle and moment symmetry during gait: A randomized controlled clinical trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(6), 1847–1855. https://doi.org/10.1016/j.arthro.2022.01.048
Lepieszkynsk, D. A. (2003). A recuperação de lesões de joelho através da musculação pela visão médica. Curitiba: Unibem.
Manoharan, A., Anish, K., & Bajaj, P. (2024). Return to sports after anterior cruciate ligament reconstruction. The Permanente Journal, 28(2), 1–7. https://doi.org/10.7812/TPP/23.345
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.
Pereira, M., Vieira, N. D. S., Brandão, E. D. R., Ruaro, J. A., Grignet, R. J., & Fréz, A. R. (2012). Tratamento fisioterapêutico após reconstrução do ligamento cruzado anterior. Acta Ortopédica Brasileira, 20(6), 372–375. https://doi.org/10.1590/S1413-78522012000600006
Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2018). Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: A systematic review and meta-analysis. The American Journal of Sports Medicine, 47(7), 1744–1753. https://doi.org/10.1177/0363546518782460
Petushek, E., Thomas, S., Kushner, A., Sugimoto, D., & Myer, G. D. (2025). Biopsychosocial profiles following ACL reconstruction: A latent class analysis of barriers to return-to-activity. Physical Therapy in Sport, 75, 144–150. https://doi.org/10.1016/j.ptsp.2025.07.003
Pinheiro, A. A. da C. (2015). Lesão do ligamento cruzado anterior: Apresentação clínica, diagnóstico e tratamento. Revista Portuguesa de Ortopedia e Traumatologia, 23(4), 320–329. https://revistas.rcaap.pt/index.php/rpot/article/view/6780
Stojanović, M. D. M., Stojiljković, N., Stanković, M., Drid, P., & Milanović, Z. (2023). Effects of eccentric-oriented strength training on return to sport criteria in late-stage anterior cruciate ligament (ACL)-reconstructed professional team sport players. Medicina, 59(6), 1111. https://doi.org/10.3390/medicina59061111
Van Melick, N., van Cingel, R. E., Brooijmans, F., Neeter, C., van Tienen, T., Hullegie, W., & Nijhuis-van der Sanden, M. W. (2016). Evidence-based clinical practice update: Practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British Journal of Sports Medicine, 50(24), 1506–1515. https://doi.org/10.1136/bjsports-2015-095898
Vidmar, M. F., Dias, J. M., Tiggemann, C. L., & Alberton, C. L. (2019). Isokinetic eccentric training is more effective than constant load eccentric training on the quadriceps rehabilitation following anterior cruciate ligament reconstruction: A randomized controlled trial. Brazilian Journal of Physical Therapy, 24(5), 405–414. https://doi.org/10.1016/j.bjpt.2019.01.002
Zebis, M. K., Aagaard, P., & Andersen, L. L. (2025). Rehabilitation after anterior cruciate ligament injury influences joint loading during walking but not hopping. British Journal of Sports Medicine, 59(7), 423–428. https://doi.org/10.1136/bjsports-2024-107123
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