(English) Episode 142-Beyond the Knee - How Your Brain's Rewiring Might Hide ACL Injury risk

The document is a Viewpoint article discussing the limitations of traditional return-to-sport (RTS) testing following anterior cruciate ligament reconstruction (ACLR) and proposing an enhanced assessment strategy. It hypothesizes that neuroplasticity, leading to neural compensation and neurocognitive reliance, is a missing factor in standard RTS criteria that contributes to reinjury risk. The authors suggest that current tests, which focus only on physical function, fail to capture this reliance, where athletes excessively use cognitive resources for movements that should be automatic. To address this, the article recommends augmenting existing RTS functional tests with dual-task challenges—integrating neurocognitive demands with physical performance—to calculate a dual-task cost, thereby detecting the degree of neurocognitive reliance before an athlete is cleared for sport. The text provides several examples of clinically feasible, low-tech, and high-tech methods for integrating these cognitive challenges, suggesting a dual-task cost greater than 10% may indicate excessive reliance.(Grooms DR, Chaput M, Simon JE, Criss CR, Myer GD, Diekfuss JA. Combining neurocognitive and functional tests to improve return-to-sport decisions following ACL reconstruction. J Orthop Sports Phys Ther [Internet]. 2023;53(8):415–9. Available from: http://dx.doi.org/10.2519/jospt.2023.11489)