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Peer-reviewedCC BY 4.0Journal of Orthopaedic Surgery and Research

Impact of neuromuscular and visuo-motor training on landing biomechanics, functional performance, and psychological factors in female athletes with unilateral anterior cruciate ligament reconstruction: a simple parallel-group randomized controlled trial

  • Ahmad Kazemi Pakdel1
  • Fereshteh Kazemi Pakdel1
  • Nader Farahpour2
  1. 1Corrective Exercises and Sports Injury Department, Faculty of Physical Education & Sport Sciences, University of Guilan, Rasht, 4199613776 Iran
  2. 2Faculty of Physical Education and Sport Science, Bu-Ali Sina University, Hamedan, 6517838695 Iran
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Abstract

Purpose: This study aims to compare the effects of neuromuscular training (NMT) and visuo-motor training (VMT) on the biomechanics of the landing task, functional performance, and psychological factors in female athletes with a history of unilateral anterior cruciate ligament reconstruction (ACLR).

Materials and methods: A total of 45 competitive female athletes (age: 27.83 ± 4.44; height: 167.58 ± 7.52 ± ; BMI: 23.4 ± 1.93) with unilateral ACLR were recruited. Participants were randomly assigned to one of three groups: the NMT group (n = 15), the VMT group (n = 15), and a control group (n = 15). Using a video camera and a force plate system, Kinematic and kinetic data were evaluated during a landing task. Functional performance was assessed through the triple hop test and the Y-Balance Test (YBT). Additionally, kinesiophobia was measured using the Short Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI). Data analysis was conducted in SPSS 28.0, employing a repeated-measures ANOVA (3 groups × 2 time points).

Results: Both the NMT and VMT showed significant improvements in peak hip flexion (p = 0.02, Effect size (EF) = 1.13 for NMT, p = 0.02, EF = 1.22 for VMT), peak knee flexion (p = 0.02, EF = 1.21 for NMT, p = 0.02, EF = 1.23 for VMT), peak dorsiflexion (p = 0.001, EF = 1.56 for NMT, p = 0.001, EF = 1.53 for VMT), peak knee valgus (p = 0.03, EF = 0.98, for NMT, p = 0.04, EF = 1.01 for VMT), GRFv (p = 0.001, EF = 1.42 for NMT, p = 0.001, EF = 1.39 for VMT), YBT (p = 0.02, EF = 1.11 for NMT, p = 0.03, EF = 1.12 for VMT), triple hop test (p = 0.02, EF = 1.15 for NMT, p = 0.02, EF = 1.16 for VMT), and ACL-RSI scale (p = 0.001, EF = 1.62 for NMT, p = 0.001, EF = 1.63 for VMT). Also, there was no significant difference between the two NMT and VMT groups in all measured variables (p > 0.05).

Conclusion: Both interventions resulted in significant improvements in the lower limbs’ angle, GRFV, and psychological factors in female athletes with unilateral ACLR. While both NMT and VMT are effective rehabilitation approaches, providing clinicians with distinct options, it is important to acknowledge key methodological limitations, including the small sample size and short follow-up duration.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13018-026-07141-3.

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BibTeX
@article{pakdel2026impact,
  title = {{Impact of neuromuscular and visuo-motor training on landing biomechanics, functional performance, and psychological factors in female athletes with unilateral anterior cruciate ligament reconstruction: a simple parallel-group randomized controlled trial}},
  author = {Ahmad Kazemi Pakdel and Fereshteh Kazemi Pakdel and Nader Farahpour},
  journal = {Journal of Orthopaedic Surgery and Research},
  year = {2026},
  month = jul,
  doi = {10.1186/s13018-026-07141-3},
  url = {https://doi.org/10.1186/s13018-026-07141-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of neuromuscular and visuo-motor training on landing biomechanics, functional performance, and psychological factors in female athletes with unilateral anterior cruciate ligament reconstruction: a simple parallel-group randomized controlled trial
AU  - Ahmad Kazemi Pakdel
AU  - Fereshteh Kazemi Pakdel
AU  - Nader Farahpour
PY  - 2026
DA  - 2026/07/31
JO  - Journal of Orthopaedic Surgery and Research
DO  - 10.1186/s13018-026-07141-3
UR  - https://doi.org/10.1186/s13018-026-07141-3
AB  - Purpose: This study aims to compare the effects of neuromuscular training (NMT) and visuo-motor training (VMT) on the biomechanics of the landing task, functional performance, and psychological factors in female athletes with a history of unilateral anterior cruciate ligament reconstruction (ACLR).  Materials and methods: A total of 45 competitive female athletes (age: 27.83 ± 4.44; height: 167.58 ± 7.52 ± ; BMI: 23.4 ± 1.93) with unilateral ACLR were recruited. Participants were randomly assigned to one of three groups: the NMT group (n = 15), the VMT group (n = 15), and a control group (n = 15). Using a video camera and a force plate system, Kinematic and kinetic data were evaluated during a landing task. Functional performance was assessed through the triple hop test and the Y-Balance Test (YBT). Additionally, kinesiophobia was measured using the Short Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI). Data analysis was conducted in SPSS 28.0, employing a repeated-measures ANOVA (3 groups × 2 time points).  Results: Both the NMT and VMT showed significant improvements in peak hip flexion (p = 0.02, Effect size (EF) = 1.13 for NMT, p = 0.02, EF = 1.22 for VMT), peak knee flexion (p = 0.02, EF = 1.21 for NMT, p = 0.02, EF = 1.23 for VMT), peak dorsiflexion (p = 0.001, EF = 1.56 for NMT, p = 0.001, EF = 1.53 for VMT), peak knee valgus (p = 0.03, EF = 0.98, for NMT, p = 0.04, EF = 1.01 for VMT), GRFv (p = 0.001, EF = 1.42 for NMT, p = 0.001, EF = 1.39 for VMT), YBT (p = 0.02, EF = 1.11 for NMT, p = 0.03, EF = 1.12 for VMT), triple hop test (p = 0.02, EF = 1.15 for NMT, p = 0.02, EF = 1.16 for VMT), and ACL-RSI scale (p = 0.001, EF = 1.62 for NMT, p = 0.001, EF = 1.63 for VMT). Also, there was no significant difference between the two NMT and VMT groups in all measured variables (p > 0.05).  Conclusion: Both interventions resulted in significant improvements in the lower limbs’ angle, GRFV, and psychological factors in female athletes with unilateral ACLR. While both NMT and VMT are effective rehabilitation approaches, providing clinicians with distinct options, it is important to acknowledge key methodological limitations, including the small sample size and short follow-up duration.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13018-026-07141-3.
SN  - 1749-799X
ER  -