Neural Plasticity and Rehabilitation Strategies After Anterior Cruciate Ligament Injury

Anterior cruciate ligament (ACL) injuries not only disrupt the structural stability of the knee joint but also induce neuromuscular control deficits from the central to the peripheral nervous systems, severely affecting patients' motor function and increasing the risk of re-injury. Neuroplasticity theory provides a novel perspective for understanding functional deficits and rehabilitation following ACL injury. This study reviews CNS alterations associated with ACL injury, encompassing subcortical spinal reflex abnormalities, reorganization of brainstem and cerebellar pathways, decreased sensory input in the cortical region, increased dependence on visual compensation for sensory integration, and inhibited motor cortex output. Rehabilitation strategies targeting CNS reorganization primarily consist of interventions aimed at modulating sensory input, strategies based on motor learning principles to optimize information integration (external focus, implicit learning, dual-task training, and biofeedback), and neuromodulation techniques directed at motor pathways. Current research is constrained by significant inter-individual variability, insufficient ecological validity of laboratory tasks, and unclear causal mechanisms underlying neural reorganization. Future research necessitates well-matched healthy controls, the development of experimental paradigms that closely mimic real-world sports, large-scale, multi-center longitudinal studies, and the integration of multimodal data from neuroimaging and biomechanics. These collective approaches aim to develop precise neurorehabilitation frameworks that optimize functional recovery and reduce the risk of re-injury in patients with ACL injuries.