Effects of visual feedback balance training on muscle strength and balance ability in patients after anterior cruciate ligament reconstruction surgery.

OBJECTIVE

To investigate the effects of visual feedback balance training on lower limb motor function in patients following anterior cruciate ligament reconstruction (ACLR), and to provide evidence for optimizing postoperative rehabilitation protocols.

DESIGN

Randomized controlled trial. METHOD: This study employed a prospective, single-blind, randomized controlled trial design. Initially, 42 patients were assigned (21 per group), with 33 ultimately completing the study (intervention group n = 17, control group n = 16). Both groups commenced a 10-week training program consisting of three sessions per week starting at week 5 postoperatively. Assessments were conducted preoperatively and postintervention using isokinetic muscle strength testing, dynamic balance testing, the Visual Analog Scale (VAS), the International Knee Disease Classification (IKDC) score, and the Lysholm score.

RESULTS

In terms of isokinetic strength of the thigh, the intervention group showed significant improvements in concentric quadriceps strength (Qc) and concentric hamstring strength (Hc) at 60°/s post-intervention (P < 0.05). In the control group, limb symmetry index (LSI) of Qc at 180°/s, as well as LSI of Hc at 60°/s and 180°/s, significantly decreased after the intervention (P < 0.05). Compared with the control group, the intervention group demonstrated significantly greater Qc and Hc at both 60°/s and 180°/s, 60°/s hamstring-to-quadriceps strength ratio (H/Q), and Qc and Hc LSI at both 60°/s and 180°/s (P < 0.05).Regarding dynamic balance, the intervention group showed significant improvements in green target performance, coordination, and stability (P < 0.05), significantly outperforming the control group across multiple metrics. The control group only showed improvement in coordination (P < 0.05). Regarding functional outcomes, the intervention group showed significant improvement in VAS and IKDC scores after the intervention (P < 0.05). However, improvement in VAS did not reach minimal clinically important difference (MCID) and was not clinically meaningful, whereas improvement in IKDC exceeded MCID. The intervention group also showed significantly greater improvements in VAS, IKDC, and Lysholm scores compared to the control group (P < 0.05).

CONCLUSION

This preliminary study suggests that visual feedback balance training may improve lower limb muscle strength, dynamic balance, and functional outcomes in patients after ACLR, though these findings require confirmation in larger, long-term trials. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07306221 registered on 20 November 2025 retrospectively registered).