Quadriceps Strength After Anterior Cruciate Ligament Reconstruction: Mechanisms of Weakness and Evidence-Based Rehabilitation Strategies
5 affiliations
- 1Orthopedics, IRCCS (Scientific Institute for Hospitalisation and Care) Maria Cecilia Hospital and San Pier Damiano H, Faenza, ITA
- 2Orthopedics and Traumatology, ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini Hospital, University of Milano, Milano, ITA
- 3Orthopedics, Villa Erbosa Hospital, Bologna, ITA
- 4Orthopedics, San Pier Damiano Hospital, GVM Care and Research, Faenza, ITA
- 5Life Sciences, Health, and Health Professions, Link Campus University, Rome, ITA
Abstract
Impairment of quadriceps strength is a frequent and clinically important problem after anterior cruciate ligament (ACL) injury and reconstruction. This dysfunction reflects muscular, neural, surgical, and rehabilitation-related mechanisms and is not solely attributable to muscle atrophy. Despite restoration of joint stability, quadriceps weakness can persist and contribute to delayed functional recovery and reduced readiness to return to sport. A comprehensive assessment should integrate clinical examination, objective isometric or isokinetic strength testing, rate of force development, functional performance, quality of movement, imaging investigations, and patient-reported and psychological measures. Rehabilitation should be initiated preoperatively and continue postoperatively with a focus on control of effusion and restoration of extension, early quadriceps activation, progressive resistance exercise, appropriate open-chain loading followed by eccentric, plyometric, and sport-specific training. Neuromuscular electrical stimulation has supportive evidence as an adjunct, and blood-flow restriction training may be useful when higher loads may not yet be tolerated. This narrative review summarizes current evidence on the mechanisms and rehabilitation of quadriceps weakness after ACL injury and ACL reconstruction, highlighting clinically relevant strategies for restoring strength and neuromuscular function.
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BibTeX
@article{zmerly2026quadriceps,
title = {{Quadriceps Strength After Anterior Cruciate Ligament Reconstruction: Mechanisms of Weakness and Evidence-Based Rehabilitation Strategies}},
author = {Hassan Zmerly and Rebecca Rauch and Erlis Velaj and Manuela Moscato and Rosaria Ipsaro Passione and Federica Dellafiore and Luigi Di Lorenzo},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118798},
url = {https://europepmc.org/article/PMC/PMC13718999},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quadriceps Strength After Anterior Cruciate Ligament Reconstruction: Mechanisms of Weakness and Evidence-Based Rehabilitation Strategies
AU - Hassan Zmerly
AU - Rebecca Rauch
AU - Erlis Velaj
AU - Manuela Moscato
AU - Rosaria Ipsaro Passione
AU - Federica Dellafiore
AU - Luigi Di Lorenzo
PY - 2026
DA - 2026/10/29
JO - Cureus
DO - 10.7759/cureus.118798
UR - https://europepmc.org/article/PMC/PMC13718999
AB - Impairment of quadriceps strength is a frequent and clinically important problem after anterior cruciate ligament (ACL) injury and reconstruction. This dysfunction reflects muscular, neural, surgical, and rehabilitation-related mechanisms and is not solely attributable to muscle atrophy. Despite restoration of joint stability, quadriceps weakness can persist and contribute to delayed functional recovery and reduced readiness to return to sport. A comprehensive assessment should integrate clinical examination, objective isometric or isokinetic strength testing, rate of force development, functional performance, quality of movement, imaging investigations, and patient-reported and psychological measures. Rehabilitation should be initiated preoperatively and continue postoperatively with a focus on control of effusion and restoration of extension, early quadriceps activation, progressive resistance exercise, appropriate open-chain loading followed by eccentric, plyometric, and sport-specific training. Neuromuscular electrical stimulation has supportive evidence as an adjunct, and blood-flow restriction training may be useful when higher loads may not yet be tolerated. This narrative review summarizes current evidence on the mechanisms and rehabilitation of quadriceps weakness after ACL injury and ACL reconstruction, highlighting clinically relevant strategies for restoring strength and neuromuscular function.
SN - 2168-8184
ER -