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

Tibor Hortobágyi; Dustin R. Grooms; Márk Váczi; Leila Bogdán; Rubén Lara Gómez; Tibor Mintál; Gergely Orsi; Nicola A. Maffiuletti; Justin W. Andrushko; Jonathan P. Farthing

doi:10.1186/s40798-025-00967-x

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

Tibor Hortobágyi^*, Dustin R. Grooms, Márk Váczi, Leila Bogdán, Rubén Lara Gómez, Tibor Mintál, Gergely Orsi, Nicola A. Maffiuletti, Justin W. Andrushko, Jonathan P. Farthing

^*Corresponding author for this work

School of Sport Exercise and Rehabilitation

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Article number	10
Number of pages	4
Journal	Sports Medicine - Open
Volume	12
Issue number	1
Early online date	9 Feb 2026
DOIs	https://doi.org/10.1186/s40798-025-00967-x
Publication status	Published - 9 Feb 2026

Keywords

Anterior cruciate ligament
Cross-education
Neuroplasticity
Rehabilitation

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title = "Time to Cross Paths: Neuroplasticity-Informed ACL Rehabilitation that Includes Cross-Education",

abstract = "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.",

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AU - Hortobágyi, Tibor

AU - Grooms, Dustin R.

AU - Váczi, Márk

AU - Bogdán, Leila

AU - Gómez, Rubén Lara

AU - Mintál, Tibor

AU - Orsi, Gergely

AU - Maffiuletti, Nicola A.

AU - Andrushko, Justin W.

AU - Farthing, Jonathan P.

PY - 2026/2/9

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AB - 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.

KW - Anterior cruciate ligament

KW - Cross-education

KW - Neuroplasticity

KW - Rehabilitation

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ER -

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

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Keywords

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