Does brain functional connectivity contribute to musculoskeletal injury? A preliminary prospective analysis of a neural biomarker of ACL injury risk

Abstract

These preliminary data indicate that those who do not later sustain an ACL injury exhibit a stronger functional connection between a cortical sensory-motor region and a cerebellar region responsible for balance and coordination. These findings may help to guide development of brain-driven biofeedback training that optimizes and promotes adaptive neuroplasticity to reduce motor coordination errors and injury risk.

Real‐time biofeedback integrated into neuromuscular training reduces high‐risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation

“…Hemispheric lateralization of significant findings (i.e., right vs. left cerebellum) could be due to the small sample size in the prior study, precluding the power to detect additional effects, or possibly due to lower limb dominance, which was not reported (Diekfuss, Grooms, Yuan, et al, ). Nevertheless, somatosensory‐cerebellar connectivity throughout both hemispheres is vital for successful motor coordination and navigation (Manto et al, ) and these data identified a potential neural predisposition to ACL injury that could be investigated, and possibly modified, through further research (Diekfuss, Grooms, Yuan, et al, ). While ACL injury prevention training has been shown to reduce corticomotor excitability in the gluteus maximus relative to strength training (using transcranial magnetic stimulation) (Powers & Fisher, ), the effects of traditional ACL injury prevention training on brain functional connectivity has not been clearly established.…”

“…ACL injuries often occur during scenarios that require intricate sensorimotor coordination (Krosshaug, Nakamae, et al, ), which exemplify the critical role of the CNS in maintaining functional joint stability. In an exploratory neuroimaging study (Diekfuss, Grooms, Yuan, et al, ), females who sustained complete ACL ruptures during their competitive soccer season were matched to healthy teammates. Prospective functional magnetic resonance imaging (fMRI) revealed reduced correlation in blood‐oxygen‐level‐dependent (BOLD) signal activity at rest (i.e., functional connectivity) between the left primary somatosensory cortex (a region that processes sensory nervous system information) and the right posterior lobe of the cerebellum (a region associated with motor control) prior to the ACL injury (Diekfuss, Grooms, Yuan, et al, ).…”

“…In an exploratory neuroimaging study (Diekfuss, Grooms, Yuan, et al, ), females who sustained complete ACL ruptures during their competitive soccer season were matched to healthy teammates. Prospective functional magnetic resonance imaging (fMRI) revealed reduced correlation in blood‐oxygen‐level‐dependent (BOLD) signal activity at rest (i.e., functional connectivity) between the left primary somatosensory cortex (a region that processes sensory nervous system information) and the right posterior lobe of the cerebellum (a region associated with motor control) prior to the ACL injury (Diekfuss, Grooms, Yuan, et al, ). Hemispheric lateralization of significant findings (i.e., right vs. left cerebellum) could be due to the small sample size in the prior study, precluding the power to detect additional effects, or possibly due to lower limb dominance, which was not reported (Diekfuss, Grooms, Yuan, et al, ).…”

“…Prospective functional magnetic resonance imaging (fMRI) revealed reduced correlation in blood‐oxygen‐level‐dependent (BOLD) signal activity at rest (i.e., functional connectivity) between the left primary somatosensory cortex (a region that processes sensory nervous system information) and the right posterior lobe of the cerebellum (a region associated with motor control) prior to the ACL injury (Diekfuss, Grooms, Yuan, et al, ). Hemispheric lateralization of significant findings (i.e., right vs. left cerebellum) could be due to the small sample size in the prior study, precluding the power to detect additional effects, or possibly due to lower limb dominance, which was not reported (Diekfuss, Grooms, Yuan, et al, ). Nevertheless, somatosensory‐cerebellar connectivity throughout both hemispheres is vital for successful motor coordination and navigation (Manto et al, ) and these data identified a potential neural predisposition to ACL injury that could be investigated, and possibly modified, through further research (Diekfuss, Grooms, Yuan, et al, ).…”

Electrocortical dynamics differentiate athletes exhibiting low‐ and high‐ ACL injury risk biomechanics

“…Other prospective investigations have demonstrated alterations in functional behavior prior to an ACL injury (e.g., ImPACT testing (Swanik, Covassin, Stearne, & Schatz, ) and/or muscle activation and strength (Grindstaff, Jackson, Garrison, Diduch, & Ingersoll, )), but did not include any direct measurements of brain activity (i.e., EEG or fMRI). The results of these prospective studies must be cautiously interpreted as the samples sizes were extremely limited (excluding (Swanik et al, )) with less than six total ACL injured participants in all three studies ( n = 1 (Grindstaff et al, ); n = 2 (Diekfuss, Grooms, Yuan, et al, ); and n = 3 (Diekfuss, Grooms, Nissen, et al, )). However, considering the combined evidence from EEG, fMRI, and functional behavior data in ACL injured participants compared to uninjured controls—both prior to and following recovery from injury—it is possible that dysfunctional neural behavior contributes significantly to ACL injury risk.…”