Efficacy of a multimodal rehabilitation program for enhancing long-term neuromuscular and functional recovery after ACL reconstruction: A randomized controlled trial

Residual neuromuscular deficits are common following anterior cruciate ligament reconstruction (ACLR), potentially limiting full functional recovery. While surgical techniques have advanced, long-term outcomes are largely determined by rehabilitation quality. Multimodal rehabilitation programs integrating various training modalities may enhance and sustain neuromuscular adaptations beyond traditional physiotherapy approaches . This study aimed to evaluate the durability of neuromuscular and functional adaptations at 6- and 12-month follow-ups following a structured multimodal rehabilitation program in individuals after ACLR. A randomized controlled trial was performed on 90 participants (Group A: experimental; Group B: control) with comparable baseline characteristics (p > 0.05). The experimental group received a 6-week supervised multimodal intervention with 12-month follow-up incorporating concentric–eccentric strengthening, balance training, endurance exercises, and functional retraining, while the control group underwent standard physiotherapy. Outcome measures included muscle power (concentric and eccentric), endurance, isometric strength, dynamic balance, and patient-reported scores—Knee Injury and Osteoarthritis Outcome Score (KOOS), Cincinnati Knee Rating Scale (CKRS), and Oxford Knee Score (OKS)—assessed at baseline, 6 weeks, 6 months, and 12 months. The experimental group demonstrated significant gains in concentric power (+100.3%), eccentric power (+138.3%), endurance (+25.2%), and isometric strength (+20.6%) at 12 months, with improved balance (−41.9%) and functional outcomes (KOOS +70.1%, CKRS +61.8%, OKS +37.6%). Between-group comparisons favored the multimodal protocol (Cohen’s d = 0.25–1.14). The control group showed smaller or inconsistent improvements. Long-term, multimodal rehabilitation following ACLR results in superior and sustainable neuromuscular and functional recovery compared to conventional physiotherapy, underscoring the necessity of comprehensive, structured rehabilitation to optimize postoperative outcomes.