Background

Evidence suggests that neuromuscular alterations in patients with an anterior cruciate ligament reconstruction (ACLR) are rooted in neurocognitive and proprioceptive deficits. The aim of this study was to assess neuromuscular control of athletes with ACLR under increased cognitive and environmental challenges.

Research question

Do athletes with ACLR show a different neuromuscular response to cognitive and environmental challenges relative to controls?

Methods

Cross-sectional study. Twenty athletes who had an ACLR (age: 23.7 ± 4.3 years, 14 males, time post-surgery: 258.6 ± 54 days) and twenty uninjured controls (age: 21.4 ± 1.5 years, 14 males) performed a stepping down-task in four environmental conditions: no additional challenges, while performing a cognitive dual-task, while undergoing an unpredictable support surface perturbation, and with the cognitive dual-task and unpredictable perturbation combined. Muscle activations of the vastus medialis (VM), vastus lateralis, hamstrings medialis (HM), hamstrings lateralis (HL), gastrocnemius medialis, gastrocnemius lateralis (GL) and gluteus medius were recorded with surface EMG. A three-way ANOVA with main effects for group, dual-task and perturbation was used to compare muscle activations.

Results

Athletes with ACLR show larger HM (ES = 0.45) and HL activation (ES = 1.32) and lower VM activation (ES = 0.72), compared to controls.

Athletes with ACLR show a significantly smaller increase in VM (ES = 0.69), VL (ES = 0.53) and GL activation (ES = 0.52) between perturbed and unperturbed tasks compared to controls. Furthermore, under cognitive loading a significantly larger decrease in HM activation (ES = 0.40) and (medial) co-contraction (ES = 0.75) was found in athletes with ACLR compared to controls.

Significance

Athletes with ACLR show an altered neuromuscular response which might represent an arthrogenic muscle response. They show less additional adaptation to perturbed tasks compared to controls, potentially as result of altered proprioceptive input. Furthermore a larger influence of increased cognitive loading on the neuromuscular control was found in athletes with ACLR, indicating that also neurocognitive limitations may contribute to altered neuromuscular control.

中文翻译：

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与未受伤的运动员相比，具有ACL重建的运动员对环境挑战表现出不同的神经肌肉反应

背景

有证据表明，前十字韧带重建术（ACLR）患者的神经肌肉改变根源于神经认知和本体感受障碍。这项研究的目的是评估在认知和环境挑战增加的情况下ACLR运动员的神经肌肉控制。

研究问题

与对照组相比，ACLR运动员对认知和环境挑战表现出不同的神经肌肉反应吗？

方法

横断面研究。20名接受ACLR的运动员（年龄：23​​.7±4.3岁，男性14岁，术后时间：258.6±54天）和20名未受伤的对照者（年龄：21.4±1.5岁，男性14岁）在四人中完成了逐步降低的任务环境条件：在执行认知双重任务，经受不可预测的支撑表面扰动以及认知双重任务和不可预测扰动相结合的同时，没有其他挑战。用表面肌电图记录了腓肠肌（VM），外侧肌，外侧肌（HM），外侧肌（HL），内侧腓肠肌，外侧腓肠肌（GL）和臀小肌的肌肉活化。使用三组方差分析对组，双重任务和摄动起主要作用，以比较肌肉的激活。

结果

与对照组相比，ACLR运动员表现出较高的HM（ES = 0.45）和HL激活（ES = 1.32）和较低的VM激活（ES = 0.72）。

与对照组相比，ACLR运动员在摄动和非摄动任务之间的VM（ES = 0.69），VL（ES = 0.53）和GL激活（ES = 0.52）的增加显着较小。此外，在认知负荷下，与对照组相比，患有ACLR的运动员的HM激活（ES = 0.40）和（中间）共收缩（ES = 0.75）的下降明显更大。

意义

患有ACLR的运动员表现出改变的神经肌肉反应，这可能代表了关节炎的反应。与控件相比，它们显示出对扰动任务的额外适应性更低，这可能是由于本体感受输入发生了变化。此外，在患有ACLR的运动员中，认知负荷增加对神经肌肉控制的影响更大，这表明神经认知限制也可能导致神经肌肉控制的改变。