Motor Control in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Domain Based Systematic Review and Narrative Synthesis of Mechanism Specific Effects.

Background: Persistent deficits in motor control following anterior cruciate ligament reconstruction suggest that conventional rehabilitation approaches fail to address underlying neurocognitive and sensorimotor mechanisms. However, how different rehabilitation strategies influence these mechanisms remains unclear. Methods: A systematic review with narrative synthesis was conducted in accordance with PRISMA guidelines. Studies evaluating motor control targeted rehabilitation interventions in anterior cruciate ligament reconstruction or relevant populations were included. Interventions were classified into five domains based on their primary mechanisms: motor learning, neuromuscular training, cognitive and dual task approaches, feedback based interventions, and environment mediated strategies. Outcomes were synthesized across biomechanical, sensorimotor, and functional domains. Results: Seven studies were included. Interventions demonstrated domain specific effects, with no single approach producing consistent improvements across all outcomes. Motor learning interventions improved movement performance and lower extremity kinematics, while cognitive and dual task approaches influenced both biomechanical and postural control outcomes. Neuromuscular training improved proprioception, whereas feedback based and environment mediated interventions showed more context specific effects. Improvements in objective outcomes were not consistently associated with patient reported measures. Conclusion: Motor control rehabilitation following anterior cruciate ligament reconstruction is mechanism dependent rather than intervention dependent. A domain-based framework provides a structured basis for aligning rehabilitation strategies with specific functional targets and may enhance the precision and effectiveness of rehabilitation.