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Background <p>Anterior cruciate ligament (ACL) injuries affect not only the musculoskeletal system but may also influence neurocognitive and psychological functions. Emerging perspectives emphasize a neuromusculoskeletal approach to post-injury recovery. However, comprehensive evaluations of brain activity, motor response, and psychological readiness—especially in comparison between primary and revision ACL cases—remain limited.</p> Methods <p>In this cross-sectional observational study, 60 male athletes aged 18–30 were allocated into three groups (<i>n</i> = 20 each): healthy controls, primary ACL reconstruction, and revision ACL reconstruction. Frontal cortical activity was assessed using theta/beta ratio via EEG (Nexus-10 system) during rest and cognitive task conditions. Reaction time was measured using a computer-based visual response test. Psychological status was evaluated using the Tampa Scale of Kinesiophobia (TSK-11) and the ACL–Return to Sport after Injury (ACL-RSI) scale.</p> Results <p>The mean frontal theta/beta ratio was highest in the revision group (eyes-open: 2.19 ± 0.45) compared to the primary ACL (1.92 ± 0.39) and control groups (1.61 ± 0.28; <i>p</i> &lt; 0.001). Mean visual reaction times were prolonged in the revision group (293 ± 25 ms) relative to the primary ACL (278 ± 19 ms) and control groups (262 ± 18 ms; <i>p</i> = 0.001). Psychological evaluation revealed higher TSK-11 scores (21.1 ± 3.2 vs. 17.5 ± 2.9 vs. 13.2 ± 2.3) and lower ACL-RSI scores (65.2 ± 9.3 vs. 76.8 ± 8.5 vs. 91.4 ± 5.6) in the revision, primary, and control groups, respectively (all <i>p</i> &lt; 0.001). Correlation analyses indicated strong associations between EEG indices, reaction time, and psychological scales.</p> Conclusion <p>ACL reconstruction, particularly revision procedures, may involve alterations in cortical activity, motor response, and psychological readiness. These results highlight the relevance of a neuromusculoskeletal perspective in post-ACL rehabilitation.</p> Trial registration <p>ClinicalTrials.gov NCT07163468. Registered on 01 September 2025 (retrospectively).</p>

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Neuromusculoskeletal alterations after ACL reconstruction: a cross-sectional study of cortical activity, motor response, and psychological readiness

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月29日

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  • Hande Baba Kaya,
  • Zekeriya Okan Karaduman,
  • Selahattin Akpınar,
  • Mehmet Arıcan,
  • Sönmez Sağlam,
  • Sevim Akşit,
  • Mustafa Koç,
  • Veysel Uludağ

摘要

Background

Anterior cruciate ligament (ACL) injuries affect not only the musculoskeletal system but may also influence neurocognitive and psychological functions. Emerging perspectives emphasize a neuromusculoskeletal approach to post-injury recovery. However, comprehensive evaluations of brain activity, motor response, and psychological readiness—especially in comparison between primary and revision ACL cases—remain limited.

Methods

In this cross-sectional observational study, 60 male athletes aged 18–30 were allocated into three groups (n = 20 each): healthy controls, primary ACL reconstruction, and revision ACL reconstruction. Frontal cortical activity was assessed using theta/beta ratio via EEG (Nexus-10 system) during rest and cognitive task conditions. Reaction time was measured using a computer-based visual response test. Psychological status was evaluated using the Tampa Scale of Kinesiophobia (TSK-11) and the ACL–Return to Sport after Injury (ACL-RSI) scale.

Results

The mean frontal theta/beta ratio was highest in the revision group (eyes-open: 2.19 ± 0.45) compared to the primary ACL (1.92 ± 0.39) and control groups (1.61 ± 0.28; p < 0.001). Mean visual reaction times were prolonged in the revision group (293 ± 25 ms) relative to the primary ACL (278 ± 19 ms) and control groups (262 ± 18 ms; p = 0.001). Psychological evaluation revealed higher TSK-11 scores (21.1 ± 3.2 vs. 17.5 ± 2.9 vs. 13.2 ± 2.3) and lower ACL-RSI scores (65.2 ± 9.3 vs. 76.8 ± 8.5 vs. 91.4 ± 5.6) in the revision, primary, and control groups, respectively (all p < 0.001). Correlation analyses indicated strong associations between EEG indices, reaction time, and psychological scales.

Conclusion

ACL reconstruction, particularly revision procedures, may involve alterations in cortical activity, motor response, and psychological readiness. These results highlight the relevance of a neuromusculoskeletal perspective in post-ACL rehabilitation.

Trial registration

ClinicalTrials.gov NCT07163468. Registered on 01 September 2025 (retrospectively).