Greater Cognitive-Motor Interference Among Patients After Anterior Cruciate Ligament Reconstruction Compared With Controls

BACKGROUND: Chaotic sporting environments require the performance of concurrent cognitive and motor tasks. A reduced capacity for either or both of the tasks when performed concurrently is known as cognitive-motor interference (CMi) and is believed to increase the injury risk. A greater susceptibility to CMi after a rupture of the anterior cruciate ligament (ACL) has been suggested to be caused by central nervous system adaptations, thus possibly contributing to high secondary ACL injury rates.

PURPOSE: To investigate whether patients after ACL reconstruction (ACLR) demonstrate greater CMi than noninjured controls when adding secondary cognitive tasks to the drop vertical jump (DVJ) and explore the potential influence of sex on CMi.

STUDY DESIGN: Controlled laboratory study.

METHODS: A total of 40 (50% male) sports-active patients who had undergone ACLR (mean, 24.9 ± 16.1 months after surgery) and 40 (50% male) sports-active noninjured controls performed DVJs with and without secondary cognitive tasks targeting short-term memory, attention, fast decision-making, and inhibitory control. Outcomes included a letter position recall task and 3 motor variables: (1) correct action (landing or landing with a subsequent vertical jump), (2) relative jump height (relative between DVJs), and (3) relative peak vertical ground-reaction force (relative between DVJs). Participants also completed isolated cognitive tests (CANTAB) included as covariates in multivariate analysis.

RESULTS: Multivariate analysis of variance revealed that the ACLR group had greater CMi than the control group (P < .001), as manifested by more incorrect answers for the cognitive letter recall task (mean difference [MD], -13.3% [95% CI, -20.8% to -5.9%]; P < .001), more incorrect motor actions (MD, -7.5% [95% CI, -12.4% to -2.6%]; P = .003), and a reduced relative jump height (MD, -4.5% [95% CI, -7.9% to -1.2%]; P = .010). No difference in relative peak vertical ground-reaction force was found (MD, 2.8% [95% CI, -7.7% to 13.3%]; P = .59). Isolated cognitive outcomes did not affect these results, and there were no significant differences between male and female participants.

CONCLUSION: Patients after ACLR showed greater CMi than noninjured controls, which was unrelated to isolated cognitive outcomes, thus indicating aberrant neurocognitive function.

CLINICAL RELEVANCE: Clinicians should consider cognitive and dual-task training and screening during ACL rehabilitation to better prepare patients for chaotic and uncontrolled sporting environments in which dual tasking is prevalent. Such interventions may help to reduce the risk of secondary ACL injuries.