The Neuroplastic Outcomes from Impaired Sensory Expectations (NOISE) hypothesis: How ACL dysfunction impacts sensory perception and knee stability

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice Pub Date : 2024-11-19 DOI:10.1016/j.msksp.2024.103222

Amber J. Schnittjer , Janet E. Simon , Tyler T. Whittier , Dustin R. Grooms

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引用次数: 0

Abstract

Background

The anterior cruciate ligament (ACL) is integral to maintaining knee joint stability but is susceptible to rupture during physical activity. Despite surgical restoration of passive or mechanical stability, patients struggle to regain strength and prior level of function. Recent efforts have focused on understanding how ACL-related changes in the nervous system contribute to deficits in sensorimotor control following injury and reconstruction. We hypothesize that these challenges are partially due to an increase in sensorimotor uncertainty, a state that reduces the precision of movement control.

Objectives

This review proposes the ACL NOISE (Neuroplastic Outcomes from Impaired Sensory Expectations) hypothesis, reframing current literature to provide a case that increased sensory noise following ACL injury and reconstruction disrupts sensory predictions, which are anticipations of immediate sensory outcomes or motor commands. This disruption in sensory predictions may contribute to altered neurophysiology, such as cross-modal brain activity, and other persistent clinical deficits.

Design

Narrative review

Results/findings

Following ACL injury and reconstruction, the knee and nervous system experience various neurophysiological alterations to overcome elevated sensory uncertainty and inaccurate sensory predictions, contributing to persistent motor deficits.

Conclusions

We provide a theoretical case based on compelling evidence that suggests prolonged impairment after ACL injury may be secondary to uncertainty in knee sensory perception. Future research should consider testing the NOISE hypothesis by creating a paradigm that examines dynamic joint stability in response to unexpected perturbations. This approach would help assess motor coordination errors and drive the development of clinical strategies aimed at reducing sensory uncertainty following ACL reconstruction.

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感官期望受损的神经可塑性结果（NOISE）假说：前交叉韧带功能障碍如何影响感官知觉和膝关节稳定性

背景前十字韧带（ACL）是维持膝关节稳定性不可或缺的部分，但在体育锻炼中很容易断裂。尽管通过手术恢复了被动或机械稳定性，但患者仍难以恢复力量和先前的功能水平。最近的研究重点是了解神经系统中与前交叉韧带相关的变化是如何导致受伤和重建后的感觉运动控制缺陷的。我们假设这些挑战部分是由于感觉运动不确定性的增加造成的，这种状态会降低运动控制的精确性。本综述提出了前交叉韧带NOISE（受损感觉预期的神经可塑性结果）假说，对目前的文献进行了重构，以证明前交叉韧带损伤和重建后感觉噪音的增加会扰乱感觉预测，而感觉预测是对直接感觉结果或运动指令的预期。前交叉韧带损伤和重建后，膝关节和神经系统会经历各种神经生理变化，以克服感觉不确定性的增加和不准确的感觉预测，从而导致持续性运动障碍。未来的研究应考虑通过创建一个范例来测试 "噪声 "假说，该范例将检查动态关节稳定性对意外扰动的反应。这种方法将有助于评估运动协调错误，并推动旨在减少前交叉韧带重建后感觉不确定性的临床策略的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Musculoskeletal Science and Practice Health Professions-Physical Therapy, Sports Therapy and Rehabilitation

CiteScore

4.10

自引率

8.70%

发文量

152

审稿时长

48 days

期刊介绍： Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.