Effects of 8-Week Exhausting Deep Knee Flexion Flywheel Training on Persistent Quadriceps Weakness in Well-Trained Athletes Following Anterior Cruciate Ligament Reconstruction.

Persistent quadriceps weakness after anterior cruciate ligament (ACL) reconstruction is a common hurdle to efficient rehabilitation. Therefore, we evaluated a new treatment strategy for athletes with ACL reconstruction. Eleven athletes with unilateral ACL reconstruction performed one set of flywheel Bulgarian split squats to exhaustion with a maximum knee extension of 60°, over 16 sessions, on their reconstructed limb. Quadriceps rate of force development (RFD) 0-50 ms (RFD 0-50 ms ), and 0-150 ms (RFD 0-150 ms ), maximum voluntary isometric contraction (MVIC), and central activation ratio (CAR) were measured bilaterally on the week before and after the intervention. In the reconstructed limb, the RFD 0-50 ms ( p = 0.04; Cohen's d = 0.8) and RFD 0-150 ms ( p = 0.03; d = 0.9) increased after training. Before-after changes in MVIC and CAR were not significant ( p > 0.05), but the lower the baseline MVIC, the greater the gain in MVIC ( r = -0.71, p = 0.02). The between-leg difference in MVIC changed from large before ( p = 0.01; d = 0.8) to small after training ( p = 0.04; d = 0.4). One set of deep knee flexion flywheel Bulgarian split squats to exhaustion improved quadriceps deficits in well-trained athletes with ACL-reconstruction, particularly those with relatively low quadriceps force production.