Thomas Zachary M, Lupowitz Lewis, Ivey Morgan, Wilk Kevin E
Piedmont Orthopedics and Sports Medicine.
Northwell Health.
Int J Sports Phys Ther. 2024 Dec 1;19(12):1629-1641. doi: 10.26603/001c.126270. eCollection 2024.
Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury including altered proprioception, impaired motor control, muscle recruitment and heightened reliance on visual feedback. This suggests a shift from subconscious movement, to movements that require increased volitional control, which may contribute to increased risk of re-injury and thus impede return to sport.
Given the neurophysiological changes associated with anterior cruciate ligament (ACL) injury that persistent into the late stages of rehabilitation, does the integration of neurocognitive training into mid to late stage rehabilitation protocols improve functional outcomes and reduce the risk of re-injury following ACL reconstruction (ACLR) in athletes?
The purpose of Part 2 of this clinical commentary is to offer strategies to implement neurocognitive training elements into the traditional ACLR rehabilitation (in weeks 9+) and review updated testing metrics that may better discern an athletes readiness to return to competition. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve both long-term outcomes and return to sport testing, as well as diminishing re-injury risk.
Updates to the traditional rehabilitation approach post ACLR, that include increased emphasis on neuroplastic, cognitive, and visual-motor capabilities exist. These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury.
尽管手术技术和预防方案有所改进，但前交叉韧带（ACL）损伤和再损伤的发生率仍在上升。ACL损伤还会导致多种神经可塑性和神经肌肉改变。新出现的研究强调了应对损伤后可能持续存在的神经认知缺陷的重要性，这些缺陷包括本体感觉改变、运动控制受损、肌肉募集以及对视觉反馈的高度依赖。这表明从潜意识运动转变为需要更多意志控制的运动，这可能会增加再次受伤的风险，从而阻碍运动员重返运动赛场。
鉴于与前交叉韧带（ACL）损伤相关的神经生理变化会持续到康复后期，将神经认知训练纳入中晚期康复方案是否能改善运动员ACL重建（ACLR）后的功能结局并降低再次受伤的风险？
本临床评论第二部分的目的是提供将神经认知训练元素纳入传统ACLR康复（第9周及以后）的策略，并回顾可能更好地判断运动员重返比赛准备情况的更新测试指标。提出了一个综合的康复框架，该框架纳入了身体和神经认知成分，旨在改善长期结局和重返运动测试，同时降低再次受伤的风险。
ACLR后传统康复方法已有所更新，包括更多地强调神经可塑性、认知和视觉运动能力。这些有助于使运动员为体育环境中不可预测和混乱的性质做好准备，并可能促进运动员更有效地重返运动赛场，潜在地降低再次受伤的风险。
5级。
