Anterior Cruciate Ligament Injury and Pre-Existing Neuromusculoskeletal Dysfunctions: 30 Years of Clinical Observations and Theoretical Correlation with the Kinetic Chain

Abstract

Anterior cruciate ligament (ACL) injuries are among the most studied musculoskeletal injuries and are traditionally associated with athletic activity. However, long-term clinical physiotherapy experience suggests that a considerable number of ACL injuries occur in non-athletic populations and often follow events described as “accidental”.

The aim of this article is to present 30 years of clinical observations suggesting that pre-existing neuromusculoskeletal dysfunctions—particularly in the lumbar spine—may contribute to knee joint vulnerability prior to ACL injury.

Repeated clinical findings indicated that concurrent therapeutic intervention in the lumbar region was consistently associated with significant reduction in knee pain and improved rehabilitation outcomes following ACL reconstruction.

These observations support the hypothesis that pre-injury neuromusculoskeletal imbalance may play a role in both ACL injury occurrence and recurrence. The purpose of this paper is to stimulate further research regarding the contribution of proximal neuromusculoskeletal factors to ACL injury mechanisms.

Keywords: ACL Injury; Lumbar Spine; Neuromuscular Control; Knee Pain; Kinetic Chain; Physiotherapy

Citation

Georgios Kostopoulos. Anterior Cruciate Ligament Injury and Pre Existing Neuromusculoskeletal Dysfunctions: 30 Years of Clinical Observations and Theoretical Correlation with the Kinetic Chain. WebLog J Musculoskelet Disord. wjmd.2026.f1703. https://doi.org/10.5281/zenodo.21312259