Preliminary brain-behavioral neural correlates of anterior cruciate ligament injury risk landing biomechanics using a novel bilateral leg press neuroimaging paradigm

Abstract

Anterior cruciate ligament (ACL) injury risk reduction strategies primarily focus on biomechanical factors related to frontal plane knee motion and loading. Although central nervous system processing has emerged as a contributor to injury risk, brain activity associated with the resultant ACL injury-risk biomechanics is limited. Thus, the purposes of this preliminary study were to determine the relationship between bilateral motor control brain activity and injury risk biomechanics and isolate differences in brain activity for those who demonstrate high versus low ACL injury risk. Thirty-one high school female athletes completed a novel, multi-joint leg press during brain functional magnetic resonance imaging (fMRI) to characterize bilateral motor control brain activity. Athletes also completed an established biomechanical assessment of ACL injury risk biomechanics within a 3D motion analysis laboratory. Knee abduction moments during landing were modelled as a covariate of interest within the fMRI analyses to identify directional relationships with brain activity and an injury-risk group classification analysis, based on established knee abduction moment cut-points. Greater landing knee abduction moments were associated with greater lingual gyrus, intracalcarine cortex, posterior cingulate cortex and precuneus activity when performing the bilateral leg press (all z > 3.1, p < .05; multiple comparison corrected). In the follow-up injury-risk classification analysis, those classified as high ACL injury-risk had greater activity in the lingual gyrus, parietal cortex and bilateral primary and secondary motor cortices relative to those classified as low ACL injury-risk (all z > 3.1, p < .05; multiple comparison corrected). In young female athletes, elevated brain activity for bilateral leg motor control in regions that integrate sensory, spatial, and attentional information were related to ACL injury-risk landing biomechanics. These data implicate crossmodal visual and proprioceptive integration brain activity and knee spatial awareness as potential neurotherapeutic targets to optimize ACL injury-risk reduction strategies.

The effects of sports‐related concussion history on female adolescent brain activity and connectivity for bilateral lower extremity knee motor control

“…Though this study was restricted to the data available from participants enrolled within the larger study, prior literature supported our final sample size as adequate for the proposed analyses. Specifically, statistically significant differences in neural activity during the bilateral fMRI leg press were reported when classifying groups by ACL injury risk landing biomechanics with a total n = 9 (high injury risk n = 4, low injury risk n = 5) (Grooms et al, 2022). Statistically significant relationships in bilateral fMRI leg press neural activity and biomechanics related to ACL injury risk were also reported with a total n = 29 (ACL injury risk landing variables) and n = 17 (in‐scanner coordination metrics) (Grooms et al, 2022; Slutsky‐Ganesh et al, 2023).…”

“…Specifically, statistically significant differences in neural activity during the bilateral fMRI leg press were reported when classifying groups by ACL injury risk landing biomechanics with a total n = 9 (high injury risk n = 4, low injury risk n = 5) (Grooms et al, 2022). Statistically significant relationships in bilateral fMRI leg press neural activity and biomechanics related to ACL injury risk were also reported with a total n = 29 (ACL injury risk landing variables) and n = 17 (in‐scanner coordination metrics) (Grooms et al, 2022; Slutsky‐Ganesh et al, 2023). Thus, a total n = 38 (history of SRC group n = 19, matched controls n = 19) was considered appropriately powered for this preliminary study.…”

“…We utilized previously published methods to design a lower extremity motor control apparatus that permitted bilateral lower extremity movement during fMRI. The MRI‐compatible lower extremity motor control apparatus used in this study was an extension from the previously described unilateral task (Anand et al, 2021; Grooms et al, 2022). In brief, the lower extremity motor control apparatus is comprised of two independent horizontal sliding foot pedals which allow for individual unilateral movement, as well as bilateral and alternating movement (Figure 1).…”

“…Thus, potential lingering alterations in neural activity important for the coordination of dynamic lower extremity movements in athletes with a history of SRC is unknown. Recent methodological advances now allow for high‐quality fMRI data to be acquired while participants perform more dynamic lower extremity motor control tasks including ankle plantarflexion/dorsiflexion, isolated knee flexion/extension movements, simulated gait, and simulated bilateral lower extremity landing (Criss et al, 2020; Grooms et al, 2019, 2022; Jaeger et al, 2014; Newton et al, 2008). Three‐dimensional motion analysis methods integrated in the MR environment now further permit concurrent biomechanical quantification of lower extremity movement during fMRI scanning (Anand et al, 2021; Anand, Diekfuss, Bonnette, et al, 2020; Strong et al, 2023).…”

“…Three‐dimensional motion analysis methods integrated in the MR environment now further permit concurrent biomechanical quantification of lower extremity movement during fMRI scanning (Anand et al, 2021; Anand, Diekfuss, Bonnette, et al, 2020; Strong et al, 2023). Supported by these technological advancements, we aimed to evaluate brain function (i.e., BOLD signal activity and connectivity) during a motor control task, consisting of bilateral ankle, knee, and hip flexion/extension movement against resistance (i.e., bilateral leg press) (Grooms et al, 2022; Slutsky‐Ganesh et al, 2023), in female adolescent athletes with a history of SRC relative to matched controls. We hypothesized that female adolescent athletes with a history of SRC would exhibit distinct neural strategies during a lower extremity motor control task relative to controls.…”