From Control to Chaos: Visual-Cognitive Progression During Recovery From ACL Reconstruction

Abstract

BACKGROUND: Anterior cruciate ligament tear is a serious knee injury with implications for central nervous system (CNS) plasticity. To perform simple knee movements, people with a history of anterior cruciate ligament reconstruction (ACL-R) engage cross-modal brain regions, and when challenged with cognitive-motor dual tasks, physical performance deteriorates. Therefore, people with ACL-R may increase visual-cognitive neural processes for motor control. CLINICAL QUESTION: What components of CNS plasticity should the rehabilitation practitioner target with interventions, and how can practitioners augment rehabilitation exercises to target injury associated plasticity? KEY RESULTS: This clinical commentary (1) describes the neurophysiological foundation for visual-cognitive compensation after ACL-R, (2) provides a theoretical rationale for implementing visual-cognitive challenges throughout the return-to-sport continuum, and (3) presents a framework for implementing visual-cognitive challenges from the acute phases of rehabilitation. The Visual-Cognitive Control Chaos Continuum (VC-CCC) framework consists of five training difficulties that progress visual-cognitive challenges from high control to high chaos to better represent the demands of sport. CLINICAL APPLICATION: The VC-CCC framework augments traditional rehabilitation so that each exercise can progress to increase difficulty and promote sensorimotor and visual-cognitive adaptation after ACL-R. J Orthop Sports Phys Ther 2024;54(7):431-439. Epub 4 June 2024. doi:10.2519/jospt.2024.12443