Time to Cross Paths: Neuroplasticity-Informed ACL Rehabilitation that Includes Cross-Education

The efficacy of anterior cruciate ligament (ACL) rehabilitation following reconstruction surgery is sub-optimal and the return-to-sport criteria are inconsistent. We examine the hypothesis that the dysfunctional neuroplasticity induced by an ACL injury could be resolved faster when cross-education is combined with innovative paradigms incorporating visual-cognitive tasks to reduce attentional compensation. We posit that the priming effects could be amplified if therapists combined higher force, eccentric based cross-education exercises with visual-cognitive dual-tasking. The overlapping nature of neuroplasticity after an ACL injury and that induced by cross education may provide a pathway to not only address the mechanical muscle strength deficits associated with injury, but the underlying neurological deficits as well. We provide a practical guide to how neuroplasticity-informed ACL rehabilitation that includes cross-education might accelerate recovery from an ACL injury and the subsequent reconstruction surgery.