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Neurocognitive Changes and Advanced Testing Approaches in Anterior Cruciate Ligament Injuries: Review
Büşra Tamgüç1, Yaren Kıvanç2, Ilknur Atkın3, Berkay Eren Pehlivanoğlu41Department of Physiotherapy and Rehabilitation, Bahçeşehir University, Doctoral Program, Graduate Institute of Graduate Education, İstanbul, Türkiye; Department of Physiotherapy and Rehabilitation, İstanbul Nişantaşı University Faculty of Health Sciences, İstanbul, Türkiye2Department of Physiotherapy and Rehabilitation, Bahçeşehir University, Doctoral Program, Graduate Institute of Graduate Education, İstanbul, Türkiye
3Department of Physiotherapy and Rehabilitation, Bahçeşehir University, Doctoral Program, Graduate Institute of Graduate Education, İstanbul, Türkiye; Department of Therapy and Rehabilitation, İstanbul Arel University, Physiotherapy Program, İstanbul, Türkiye
4Department of Physiotherapy and Rehabilitation, Bahçeşehir University Faculty of Health Sciences, İstanbul, Türkiye
Anterior cruciate ligament (ACL) injuries are one of the most common injuries experienced by athletes. ACL injuries not only have effects on the musculoskeletal system, but can also lead to significant changes in neurocognitive processes. This study examines 46 studies published between 2018 and 2024. Keywords such as sensorimotor dysfunction, visual reliance, return to play/sports, neuroscience, and neural plasticity/neuroplasticity were used in searches conducted on PubMed, Web of Science, Scopus, and Google Scholar. The review provides an in-depth analysis under the headings of ACL injuries, neurocognitive abilities, neural compensations, visual reliance, and the development of return-to-sport (RTS) tests. ACL injuries lead to neurocognitive changes that affect athletes’ motor control, attention, and executive functions. Impairments in these functions can result in coordination deficits and increased injury risk. Visual reliance emerges as a compensatory mechanism used by the central nervous system (CNS) to address proprioceptive deficits following ACL injuries. However, heightened visual-cognitive demands may prolong decision-making times and reduce movement efficiency in athletes. Neural compensation processes involve neuroplasticity and adaptive changes to recover lost sensorimotor functions. During this process, the CNS requires increased brain activation to maintain motor control. Moreover, advanced RTS tests developed post-ACL injury aim to evaluate not only biomechanical performance but also neurocognitive functions. In conclusion, investigating neurocognitive changes following ACL injuries offers novel insights into rehabilitation strategies. Neurocognitive-enhanced RTS tests and rehabilitation programs to account for these changes can better support athletes’ functional and cognitive recovery.
Keywords: Anterior cruciate ligament injuries, brain plasticity, return to sports, sensorimotor dysfunction.
Manuscript Language: English