Inhibition of Motor Planning and Response Selection after Anterior Cruciate Ligament Reconstruction

Abstract

Purpose: The purpose of this study is to compare cortical motor planning activity during response selection and motor execution processes between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a reaction time and response selection task. Methods: Individuals with ACLR (n = 20) and controls (n = 20) performed a lateralized choice reaction time (e.g., Go/NoGo) task. Electrocortical activity and reaction time were recorded concurrently using electroencephalography and inertial measurement units. Separate stimulus locked and response-locked event-related potentials were computed for each limb. The lateralized readiness potential (LRP) was computed as the interhemispheric differences between waveforms and the mean LRP area and onset latency were recorded. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) and the associations between LRP characteristics and response performance (number of errors) were assessed. Results: Participants with ACLR have had smaller LRP area during periods of response selection (P = 0.043, d = 0.4) and motor execution (P = 0.015, d = 0.5) and committed more errors in both Go (P < 0.001, d = 0.8) and NoGo (P = 0.032, d = 0.5) response conditions. There were no differences in latency of response selection or motor execution. Participants with ACLR had higher active motor thresholds (P < 0.001, d = 1.3) than controls, which was weakly associated with smaller LRP areas (r = 0.32-0.42, P < 0.05). Conclusions: The ACLR group demonstrated greater motor planning and response inhibition during a choice reaction time task. More errant performance also suggests poorer decision making in the presence of a "speed-accuracy" trade-off. Key features of the sample, including lower corticospinal excitability, lend support to an interpretation of widespread cortical inhibition contributing to impairments in response selection and motor execution.

Lack of Proprioceptive Strategy Modulation Leads to At-Risk Biomechanics for Anterior Cruciate Ligament in Healthy Athletes

“…Two prospective studies have identified decreased brain functional connectivity between cortical sensory and motor regions before ACL injuries (10,11). This altered connectivity may lead to an inability to react to environmental changes such as opponent behavior during dual tasks (15,19). Interestingly, alterations in brain regions responsible for proprioceptive reweighting have been reported after ACL injuries (20)(21)(22) and could further explain the risk of recurrences.…”