Exploring the Brain After ACL Reconstruction: Examination of Neurophysiological and Psychological Factors During the Course of Post-Operative Rehabilitation.

摘要

upture of the anterior cruciate ligament (ACL) is a devastating injury affecting approximately 250,000 individuals each year in the United States. Upwards of 130,000 anterior cruciate ligament reconstructions (ACLR) are performed each year. While ACLR restores mechanical stability of the knee, many patients continue to experience functional performance deficits, reduced capacity for physical activity and participation, and second injury. Current rehabilitation strategies may not be sufficiently addressing neurophysiologic alterations and psychological factors related to injury. An improved understanding of these factors may result in more effective post-operative rehabilitation protocols, fewer second injuries and safer return to sports.;The overall goals of this work were: 1) to compare corticospinal, intracortical, and spinal-reflexive excitability in athletes after ACLR and controls, and explore the relationship of these neurophysiologic measures to quadriceps strength, 2) to explore the relationship between psychological readiness to return to sport and gait biomechanics, and 3) to determine if a secondary ACL injury prevention program affects psychological readiness to return to sport and if an improvement in psychological readiness is associated with better outcomes.;This work includes data from two distinct studies. For goal ;Athletes after ACLR demonstrated alterations in corticospinal, and intracortical excitability early after surgery compared to controls, and these neurophysiologic measures were associated with isometric quadriceps strength during the course of rehabilitation. Changes in these measures did not occur throughout rehabilitation indicating that current rehabilitation may not be addressing cortical alterations associated with chronic quadriceps dysfunction. For goals