What is visual-motor training after ACL surgery?

Visual-motor training adds visual challenges to movement drills, so the athlete must process what they see while moving. In this trial it worked about as well as standard neuromuscular training.

Did the training reduce ACL reinjury?

The study did not measure reinjuries. It showed better landing mechanics, balance, hop performance and confidence, which are considered important for a safe return to sport.

Who was in the study?

45 competitive female athletes, average age about 28, who had ACL reconstruction on one knee. They were split evenly into neuromuscular training, visual-motor training and control groups.

Research Summary

Neuromuscular and Visual-Motor Training Both Improved Landing and Confidence After ACL Surgery in Female Athletes

By KneePainNews Editorial Team · November 3, 2026 · Editorial Standards

Not medical advice. This is a plain-English summary for general information. Talk to your doctor or physical therapist before changing your care. Read our medical disclaimer.

Two different training programs both helped female athletes land more safely and feel more ready to return to sport after ACL reconstruction, a small randomized trial found. The study was published in the Journal of Orthopaedic Surgery and Research in 2026.

What was studied

Women who have had anterior cruciate ligament (ACL) reconstruction often keep landing patterns, such as the knee caving inward, that are linked to reinjury. Researchers in Iran compared two approaches. Neuromuscular training (NMT) focuses on strength, balance and movement control. Visual-motor training (VMT) challenges the athlete to move while processing visual information.

They randomized 45 competitive female athletes (average age about 28) with one reconstructed knee into an NMT group, a VMT group, or a control group, 15 in each. Landing was measured with video and a force plate, and they also did the triple hop test, the Y-Balance Test, and a questionnaire on psychological readiness and fear of reinjury (ACL-RSI).

Key findings

Both programs improved hip, knee and ankle bending during landing and reduced inward knee collapse (valgus).
Both lowered vertical landing impact forces.
Both improved balance and hop test performance.
Both improved psychological readiness to return to sport.
There was no meaningful difference between the two training types on any measure.

What it means for people with knee pain

If you are rehabbing after ACL surgery, structured training that works on movement control, whether traditional neuromuscular drills or visual-motor challenges, may help you land better and regain confidence. Ask your physical therapist which approach fits your sport and stage of recovery.

Limitations

The study was small, included only women, and had a short follow-up, which the authors acknowledge. It measured movement and test scores, not actual reinjury rates, so it cannot show whether either program prevents a second ACL tear.

Source: Pakdel AK, Pakdel FK, Farahpour N. Impact of neuromuscular and visuo-motor training on landing biomechanics, functional performance, and psychological factors in female athletes with unilateral anterior cruciate ligament reconstruction: a simple parallel-group randomized controlled trial. J Orthop Surg Res. 2026;21(1):617. doi:10.1186/s13018-026-07141-3. PMID 42947231. Read the original

Frequently asked questions

What is visual-motor training after ACL surgery?: Visual-motor training adds visual challenges to movement drills, so the athlete must process what they see while moving. In this trial it worked about as well as standard neuromuscular training.
Did the training reduce ACL reinjury?: The study did not measure reinjuries. It showed better landing mechanics, balance, hop performance and confidence, which are considered important for a safe return to sport.
Who was in the study?: 45 competitive female athletes, average age about 28, who had ACL reconstruction on one knee. They were split evenly into neuromuscular training, visual-motor training and control groups.

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