Distinct Movement-Related Cortical Control Following Anterior Cruciate Ligament Injury: A Scoping Review
Sports medicine - open · 2026
ACL patients show different brain activity patterns during movement than controls, but there's still no solid evidence this actually affects how they move.
The paper
Scoping review, 25 studies (416 ACL patients total on study level), synthesizing EEG/fMRI/fNIRS studies of cortical activity during motor tasks in ACL-injured vs healthy controls.
What they found
21 of 25 studies found significant between-group differences in brain activity, mainly increased frontal and visual-processing region activity, with inconsistent motor/parietal cortex findings; of 14 studies also reporting behavioral data, 10 found no performance differences and only 4 reported impaired motor performance.
The appraisal
This is a scoping review, not a meta-analysis — no pooled effect sizes, no statistical synthesis, and by design no formal risk-of-bias grading across the 25 heterogeneous primary studies (mixed EEG/fMRI/fNIRS, different tasks, different timepoints post-injury/reconstruction). The headline 'distinct cortical activity' finding is essentially unlinked to function: most studies that measured behavior found no performance difference, so the neuroimaging signal has unclear clinical meaning. Useful for mapping the field, but says nothing about causation, magnitude, or whether these cortical changes are adaptive, maladaptive, or incidental.
The gap
Whether altered cortical recruitment actually drives clinically relevant deficits (reinjury risk, movement quality, return-to-sport readiness) is unresolved — the review itself says this link 'remains hypothetical', and no dual-task or longitudinal causal study yet exists to test it.
Landmark context
This builds on the established sensorimotor/neuroplasticity model of ACL injury (e.g. Grooms and Needle's neurocognitive framework proposing central nervous system adaptations after ACL injury), extending it by systematically cataloguing the neuroimaging evidence base rather than testing a new hypothesis.
What to do Monday
No — this doesn't change Monday's clinic. It doesn't validate dual-task or cognitive-loading rehab protocols as superior; at most it strengthens the rationale for researchers (not clinicians yet) to test whether adding visual/cognitive dual-tasks to rehab or RTS testing improves outcomes.
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