Distinct Movement-Related Cortical Control Following Anterior Cruciate Ligament Injury: A Scoping Review.

Abstract

Background: Distinct brain activity in anterior cruciate ligament (ACL) patients has been reported, yet comprehensive evidence on neural differences during movement and the potential impact on motor performance remains limited.

Objectives: This review aimed to synthesize evidence on cortical activity during motor tasks in ACL patients compared to healthy controls and explored the potential impact on motor performance.

Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodological guidance for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. Eligible literature was searched in PubMed, Embase, SPORTDiscus, and Web of Science from inception to December 31, 2025, and included primary research assessing brain activity during voluntary motor tasks in ACL patients compared to controls.

Results: Out of 233 identified records, 25 were included, with 15 utilizing electroencephalography, 8 functional magnetic resonance imaging, and 2 functional near-infrared spectroscopy assessing a total of 416 ACL patients on study level. 21 studies reported significant between-group differences in brain activity, demonstrating increased activity in frontal and visual processing regions but inconsistent findings for motor and parietal cortices. Additionally, 14 records described behavioral data alongside neuroimaging results, of which 10 found no significant differences and 4 reported impaired motor performance.

Conclusion: Distinct patterns of brain activity were demonstrated in ACL patients compared to healthy controls, predominantly depicting increased recruitment of neural resources within the cognitive and visual network. Despite some evidence reporting associated impaired motor performance, the relationship between cortical alterations and motor performance remains hypothetical. Future research should incorporate paradigms including visual and cognitive dual-tasks to explore the relationship between brain activity and behavioral outcomes.