Effect of Plyometric Training on Neuromuscular Function after Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Multi-dimensional Outcomes.

Neuromuscular deficits persist after anterior cruciate ligament reconstruction (ACLR), limiting functional recovery and increasing re-injury risk. Plyometric training (PLYO) may address these gaps, but its multi-dimensional efficacy remains unclear. The objective of this study is to evaluate the effects of on neuromuscular function across subjective outcomes, limb symmetry, strength and dynamic balance in ACLR patients. Following PRISMA guidelines (PROSPERO), 7 randomised controlled trials (RCTs) were identified from PubMed/EMBASE/MEDLINE/CENTRAL/Scopus/Web of Science (up to June 2025). Random-effects meta-analyses synthesised standardised mean differences (SMDs) or mean differences (MDs) for the key outcomes. Evidence certainty was assessed using GRADE. A total of 267 patients were included across studies. Plyometric training significantly enhanced quadriceps strength (Peak Torque: 12.06; 3.65-20.57) and overall LSI gains were clinically marginal (8.2%; 0.51-15.89). Subjective function showed inconsistent effects, with benefits linked to longer training duration (β = 0.78) and athletic populations (β = 0.65). Dynamic balance demonstrated no significant overall effect (2.90; -1.88-7.67). Plyometric training enhances strength and complex task symmetry post-ACLR, but effects on subjective function and dynamic balance are task-and population-specific. Rehabilitation programmes should prioritise individualised PLYO protocols targeting advanced neuromuscular demands. Evidence certainty was 'very low' per GRADE, urging higher-quality RCTs.