Anterior Cruciate Ligament Reconstruction (ACLR) UNDERSTANDING ACL INJURY AND REHABILITATION Key Insights into Neuromuscular Impacts and Recovery Challenges
Anterior Cruciate Ligament (ACL) injuries are among the most complex musculoskeletal injuries, not only due to structural damage but also because of their systemic neuromuscular consequences. Here are the broad impacts of ACL injury and their implications for rehabilitation.
Primary Symptoms • Pain and Swelling: Common acute symptoms post-injury, contributing to limited mobility and discomfort. • Reduced Range of Motion (ROM): Joint effusion and muscle guarding often restrict knee mobility in early stages.
NEUROLOGICAL CONSEQUENCES
SECONDARY COMPLICATIONS
Reduced Proprioception •
Patellofemoral Joint Pain Syndrome (PFJPS) • May develop due to altered gait mechanics and poor quadriceps control.
Affects both the injured and uninjured limbs.
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Impairs joint position sense and coordination, increasing injury risk.
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Must be monitored throughout rehab progression.
ACL Injury as a “Brain Injury” •
Neuroplastic changes occur early post-injury. Impacts motor control and coordination. Highlights the need for early neuromuscular re-education.
Muscle Atrophy •
Particularly significant loss of Type I (slow-twitch) fibers (up to 60–80%). Results in fatigue, reduced endurance, and impaired function.
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Functional Impacts include •
Arthrogenic Muscle Inhibition (AMI) • Reflexive inhibition of surrounding musculature, especially the quadriceps. • Disrupts voluntary activation, prolonging recovery. • Requires targeted neuromuscular strategies (e.g., NMES, eccentric loading).
Gait Abnormalities: Compensatory patterns may persist even post-rehabilitation. Reduced Functional Performance: Impairs return to sport and daily activities. Loss of Strength Symmetry: • Evaluated using Leg Symmetry Index (LSI). • Persistent deficits increase reinjury risk.
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