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Neurocognition in patients with ACL injuries

How about integrating cognitive and neurophysiological principles in ACL rehabilitation?

Most athletes who sustain an anterior cruciate ligament (ACL) rupture undergo surgery with the expectation to return to sports and achieving preinjury function levels. Although 81 percent of athletes return to sports, only 55 percent return to competitive sports after ACL injury.

RTS protocols are mainly based on biomechanical measures. However, the demands of sports are more complex, and athletes are required to make quick decisions especially in field and team sports. This systematic review aimed to determine the impact of neurocognitive performance on ACL reinjury and tried to present a framework that integrates the cognitive and neurophysiological principles in the assessment and rehabilitation of ACL injuries.

These findings indicate that athletes have neurocognitive and CNS changes after ACL injury, even after returning to sports. The high rate of reinjury might indicate that the athletes may not be adequately prepared to return to sports. Currently rehabilitation focuses on physical capacity to restore strength, power, and endurance. However, these athletes might require rehabilitation for cognitive aspects of performance as well, to prepare them for real world sports situations.

> From: Piskin et al., Sports Health (2021) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

Neurocognitive function in relation to ACL injury and reinjury risk is rarely looked at in ACL rehabilitation. This review therefore is a great start to see what has been published in this field.

In the paper some of its limitations are recognised: the tasks that have been used in the studies vary and might not reflect sports-relevant cognition. This makes it difficult to compare and summarise findings. Moreover, it makes it impossible to apply findings into practice.

Nevertheless, it is a great start, and we hopefully watch this area in future research.     

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