Corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament injury

In the present report, we investigated changes in corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament (ACL) injury. Ten participants, each with a previous history of unilateral ACL injury (median time post-injury 22 months) and eight healthy controls underwent transcranial magnetic stimulation (TMS) to assess excitability of the lower limb motor representation. Resting motor thresholds (RMTs) and stimulus response curves were measured at rest, while amplitude of motor evoked potentials and silent period duration were measured during active contraction. Correlations between these indices of excitability and three clinical measures of knee function were identified. Paired comparisons of indices by hemisphere revealed an asymmetry only in RMTs, which were significantly reduced on the side of injury in the ACL group. Correlations with clinical measures showed that the extent of quadriceps motor representation, as reflected by the steepness of SR curves, was strongly associated with quadriceps strength (r 2=0.71) on the injured side. The RMT asymmetry reported here in the context of ACL injury is consistent with other recent reports describing enhanced excitability of corticomotor projections targeting muscles adjacent to an immobilized or a painful joint. In such conditions, alterations in the quantity and quality of sensory feedback from the affected limb may underlie the rise in cortical excitability.