Neuromusculoskeletal alterations after ACL reconstruction: a cross-sectional study of cortical activity, motor
Hande Baba Kaya1, Zekeriya Okan Karaduman2, Selahattin Akpınar3
1Faculty of Sports Sciences, Department of Physical Education and Sports Teaching, Düzce University, Duzce, Türkiye.
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).
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