Open Access Research article

Effect of cross exercise on quadriceps acceleration reaction time and subjective scores (Lysholm questionnaire) following anterior cruciate ligament reconstruction

Maria G Papandreou1*, Evdokia V Billis2, Emmanouel M Antonogiannakis3 and Nikos A Papaioannou4

Author Affiliations

1 School of Physiotherapy, Faculty of Health Sciences, Technological Education Institute (T.E.I) of Athens, Athens, Greece

2 School of Physiotherapy, Faculty of Health Sciences, Aigio, Technological Education Institute (T.E.I) of Patras, Patras, Greece

3 2nd Orthopaedic Department of 401 General Military Hospital, Athens, Greece

4 Research Laboratory of Musculoskeletal System, University of Athens, Athens, Greece

For all author emails, please log on.

Journal of Orthopaedic Surgery and Research 2009, 4:2  doi:10.1186/1749-799X-4-2

Published: 30 January 2009



Anterior cruciate ligament (ACL) injury or reconstruction can cause knee impairments and disability. Knee impairments are related to quadriceps performance – accelerated reaction time (ART) – and disability to performance of daily living activities which is assessed by questionnaires such as the Lysholm knee score. The purposes of this study were to investigate the effect of cross exercise, as supplementary rehabilitation to the early phase of ACL reconstruction: a) on quadriceps ART at the angles 45°, 60° and 90° of knee flexion and, b) on the subjective scores of disability in ACL reconstructed patients.


42 patients who underwent ACL reconstruction were randomly divided into 3 groups, two experimental and one control. All groups followed the same rehabilitation program. The experimental groups followed 8 weeks of cross eccentric exercise (CEE) on the uninjured knee; 3 d/w, and 5 d/w respectively.

Quadriceps ART was measured at 45°, 60° and 90° of knee flexion pre and nine weeks post-operatively using an isokinetic dynamometer. Patients also completed pre and post operatively the Lysholm questionnaire whereby subjective scores were recorded.


Two factor ANOVA showed significant differences in ART at 90° among the groups (F = 4.29, p = 0.02, p < 0.05). Post hoc Tukey HSD analysis determined that the significant results arose from the first experimental group in comparison to the control (D = -0.83, p = 0.01). No significant differences were revealed at 45° and 60°.

Significant differences were also found in the Lysholm score among the groups (F = 4.75, p = 0.01, p < 0.05). Post hoc analysis determined that the above significant results arose from the first experimental group in comparison with the control (D = 7.5, p < 0.01) and from the second experimental in comparison with the control (D = 3.78, p = 0.03).


CEE showed improvements on quadriceps ART at 90° at a sequence of 3 d/w and in the Lysholm score at a sequence of 3 d/w and 5 d/w respectively on ACL reconstructed patients.