Negative Emotion and Joint-Stiffness Regulation Strategies After Anterior Cruciate Ligament Injury

Abstract

Context Fear of reinjury after an anterior cruciate ligament (ACL) reconstruction (ACLR) may be associated with persistent deficits in knee function and subsequent injury. However, the effects of negative emotion on neuromuscular-control strategies after an ACL injury have remained unclear. Objective To identify how negative emotional stimuli affect neural processing in the brain and muscle coordination in patients after anterior cruciate ligament reconstruction compared with healthy control participants. Design Case-control study. Setting Neuromechanics laboratory. Patients or Other Participants Twenty patients after unilateral anterior cruciate ligament reconstruction and 20 healthy recruits. Main Outcome Measure(s) Electrocortical θ (4–8 Hz) activity (event-related synchronization, % increased power relative to a nonactive baseline) at selected electrodes placed at the frontal (F3, Fz, F4) and parietal (P3, Pz, P4) cortices using electroencephalography, neurophysiological cardiac changes (beats/min), and subjective fear perceptions were measured, along with joint stiffness (Nm/°/kg) with and without an acoustic stimulus in response to 3 types of emotionally evocative images (neutral, fearful, and knee-injury pictures). Results Both groups had greater frontoparietal θ power with fearful pictures (Fz: 35.9% ± 29.4%; Pz: 81.4% ± 66.8%) than neutral pictures (Fz: 24.8% ± 29.7%, P = .002; Pz: 64.2 ± 54.7%, P = .024). The control group had greater heart-rate deceleration with fearful (−4.6 ± 1.4 beats/min) than neutral (−3.6 ± 1.3 beats/min, P < .001) pictures, whereas the ACLR group exhibited decreased heart rates with both the fearful (−4.6 ± 1.3 beats/min) and injury-related (−4.4 ± 1.5 beats/min) pictures compared with neutral pictures (−3.4 ± 1.4 beats/min, P < .001). Furthermore, during the acoustic startle condition, fearful pictures increased joint stiffness (Nm/°/kg) in the ACLR group at the midrange (0°–20°: 0.027 ± 0.02) and long range (0°–40°: 0.050 ± 0.02) compared with the neutral pictures (0°–20°: 0.017 ± 0.01, P = .024; 0°–40°: 0.043 ± 0.02, P = .014). Conclusions Negative visual stimuli simultaneously altered neural processing in the frontoparietal cortices and joint-stiffness regulation strategies in response to a sudden perturbation. The adverse effects of fear on neuromuscular control may indicate that psychological interventions should be incorporated in neuromuscular-control exercise programs after ACL injury.