Deficits in quadriceps force control after anterior cruciate ligament injury: Potential central mechanisms

Sarah H. Ward, Luke Perraton, Kim Bennell, Brian Pietrosimone, Adam L. Bryant

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Context: Poor quadriceps force control has been observed after anterior cruciate ligament (ACL) reconstruction but has not been examined after ACL injury. Whether adaptations within the central nervous system are contributing to these impairments is unknown. Objective: To examine quadriceps force control in individuals who had sustained a recent ACL injury and determine the associations between cortical excitability and quadriceps force control in these individuals. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Eighteen individuals with a recent unilateral ACL injury (6 women, 12 men; age ¼ 29.6 6 8.4 years, height ¼ 1.74 6 0.07 m, mass ¼ 76.0 6 10.4 kg, time postinjury ¼ 69.5 6 42.5 days) and 18 uninjured individuals (6 women, 12 men; age ¼ 29.2 6 6.8 years, height ¼ 1.79 6 0.07 m, mass ¼ 79.0 6 8.4 kg) serving as controls participated. Main Outcome Measure(s): Quadriceps force control was quantified as the root mean square error between the quadriceps force and target force during a cyclical force-matching task. Cortical excitability was measured as the active motor threshold and cortical silent period. Outcome measures were determined bilaterally in a single testing session. Group and limb differences in quadriceps force control were assessed using mixed analyses of variance (2 3 2). Pearson product moment correlations were performed between quadriceps force control and cortical excitability in individuals with an ACL injury. Results: Individuals with an ACL injury exhibited greater total force-matching error with their involved (standardized mean difference [SMD] ¼ 0.8) and uninvolved (SMD ¼ 0.9) limbs than did controls (F1,27 ¼ 11.347, P ¼ .03). During the period of descending force, individuals with an ACL injury demonstrated greater error using their involved (SMD ¼ 0.8) and uninvolved (SMD ¼ 0.8) limbs than uninjured individuals (F1,27 ¼ 4.941, P ¼ .04). Greater force-matching error was not associated with any cortical excitability measures (P . .05). Conclusions: Quadriceps force control was impaired bilaterally after recent ACL injury but was not associated with selected measures of cortical excitability. The findings highlight a need to incorporate submaximal-force control tasks into rehabilitation and ‘‘prehabilitation,’’ as the deficits were present before surgery.

Original languageEnglish
Pages (from-to)505-512
Number of pages8
JournalJournal of Athletic Training
Issue number5
Publication statusPublished - May 2019
Externally publishedYes


  • Cortical excitability
  • Knee injury
  • Motor control
  • Transcranial magnetic stimulation

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