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Compensatory Movement Strategies during the Rearfoot Elevated Split Squat after ACL Reconstruction.

Megan Graham1, Amit Gohil1, Tereza Janatova1

  • 1Department of Physical Therapy, University of Kentucky, Lexington, KY.

Medicine and Science in Sports and Exercise
|February 20, 2026
PubMed
Summary
This summary is machine-generated.

Individuals with anterior cruciate ligament (ACL) injuries use compensatory movement strategies during squats, offloading the knee. A more upright posture during the rearfoot elevated split squat (RFESS) may worsen this effect, impacting rehabilitation.

Keywords:
ACL REHABILITATIONKNEEQUADRICEPSSQUAT

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Area of Science:

  • Biomechanics
  • Orthopedics
  • Sports Medicine

Background:

  • Anterior cruciate ligament (ACL) reconstruction requires careful rehabilitation to restore function.
  • The rearfoot elevated split squat (RFESS) is commonly used in ACL rehabilitation for knee extensor strengthening.
  • Understanding compensatory movement strategies is crucial for optimizing rehabilitation outcomes.

Purpose of the Study:

  • To compare inter- and intra-limb compensation strategies between ACL-involved and non-involved limbs during the RFESS.
  • To examine how trunk flexion angle influences these compensation strategies.

Main Methods:

  • Twenty-five individuals post-ACL reconstruction performed RFESS.
  • Three-dimensional motion capture and force plates were used to analyze joint kinematics, kinetics, and ground reaction forces.
  • Paired t-tests and linear regression analyzed between-limb differences and the effect of trunk flexion.

Main Results:

  • The ACL-involved limb showed altered loading patterns, with reduced vertical ground reaction forces and knee joint moments.
  • A shift in load towards the hip and ankle joints was observed in the ACL-involved limb.
  • Increased trunk flexion correlated with higher vertical ground reaction forces but not knee contribution.

Conclusions:

  • ACL-involved limbs exhibit inter- and intra-limb compensation during RFESS.
  • A more upright trunk posture during RFESS may increase inter-limb compensation and lead to greater offloading of the affected limb.
  • The RFESS may not effectively strengthen knee extensors in mid-stage ACL rehabilitation without careful monitoring due to these compensatory strategies.