OBJECTIVE: To investigate the effect of progressive resistance exercise compared with low-intensity home-based exercises on knee-muscle strength and joint function in people with anterior cruciate ligament (ACL) reconstruction and persistent hamstring strength deficits at 12 to 24 months after surgery. DESIGN: Randomized controlled superiority trial with parallel groups, balanced randomization (1 to 1), and blinded outcome assessment. METHODS: People with ACL reconstruction (hamstring autograft) and persistent hamstring muscle strength asymmetry were recruited 1 to 2 years postsurgery and randomized to either 12 weeks of supervised progressive strength training (SNG), or 12 weeks of home-based, low-intensity exercises (CON). The primary outcome was between-group difference in change in maximal isometric knee flexor muscle strength at 12-week follow-up. RESULTS: Fifty-one participants (45% women, 27 +/- 6 years) were randomized to SNG (n = 25) or CON (n = 26), with 88% follow-up rate at 12 weeks. People in the SNG group improved their knee flexor muscle strength (0.18 N x m/kg, 95% confidence interval (CI) 0.07 to 0.29; p = 0.002) more than the CON group, from baseline to 12 weeks. The SNG group also had superior Knee Injury and Osteoarthritis Outcome Scores for Pain (4.6, 95% CI 0.4 to 8.7; p = 0.031) and daily living function (4.7, 95% CI 1.2 to 8.2; p = 0.010) compared to the CON group. CONCLUSION: In people with persistent hamstring muscle strength deficits after ACL reconstruction, 12 weeks of supervised progressive strength training was superior to low-intensity home-based exercises for improving maximal knee flexor muscle strength and some patient- reported outcomes.

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