Improvement in functional movement, landing mechanics, and dynamic balance following TRX training in physically active athletes after ACL reconstruction: a randomized controlled trial

Abstract

Abstract Purpose Anterior cruciate ligament (ACL) rupture is one of the most prevalent and critical injuries experienced by athletes. The purpose of the present study was to examine the effects of a six-week TRX suspension training program on movement quality, landing mechanics, and dynamic balance in male athletes following anterior cruciate ligament reconstruction (ACLR). Methods This study was a parallel-group randomized controlled trial (1:1 allocation) with blinded outcome assessment. Male athletes with a history of ACLR using a hamstring autograft, at least three years of sports participation, and a minimum of nine months post-surgery were randomly assigned to either a supervised six-week TRX suspension training program or traditional rehabilitation. Primary outcomes included Functional Movement Screen (FMS), Landing Error Scoring System (LESS), and Y-Balance test (anterior, posteromedial, posterolateral, and composite reach). Between-group differences were analyzed using a two-way mixed ANOVA (Group × Time). Results After six weeks, the TRX group demonstrated significantly greater improvements than the traditional rehabilitation group in dynamic balance across anterior (F = 33.527, p < 0.001), posteromedial (F = 68.266, p < 0.001), posterolateral (F = 67.187, p < 0.001), and composite reach (F = 68.238, p < 0.001). Movement quality improved substantially, with higher FMS scores in the TRX group (F = 251.994, p < 0.001). Landing mechanics also improved, as reflected by lower LESS scores in the TRX group (F = 75.385, p < 0.001). Conclusion A six-week TRX suspension training program resulted in superior improvements in movement quality, landing mechanics, and dynamic balance compared with traditional rehabilitation in male athletes following ACLR. These findings suggest that instability-based, multi-planar training may improve functional movement, landing mechanics, and dynamic balance during advanced rehabilitation phases before return to sport. Trial registration This study was registered a priori with IRCT20250519065806N1 on 27 May 2025.