Anterior cruciate ligament (ACL) injuries significantly impact athletes’ performance, and a neurocognitive approach, particularly executive functions, may play a relevant role in ACL injury. The aim was to evaluate and compare performance on inhibitory control and visual attention using the Flanker Task and Multiple Object Tracking (MOT) cognitive tests between athletes with and without a history of non-contact ACL injury. 60 athletes of interaction sports (30 athletes with no history of ACL injury and 30 athletes with a history of non-contact ACL injury) participated in this study. During the experimental session participants performed Flanker Task and Multiple Object Tracking to evaluate inhibitory control and visual attention, respectively. Athletes with a history of non-contact ACL injury had longer reaction times than healthy athletes on the Flanker Task cognitive test (p < 0.001). For the MOT, athletes with a history of non-contact ACL injury had worse two-ball follow-through at speeds of 19.9 deg/s (p = 0.034) and 28.8 deg/s (p < 0.001) and three-ball follow-through at speeds of 19.9 deg/s (p = 0.009) and 28.8 deg/s (p < 0.001). Athletes with a history of non-contact ACL injury exhibit poorer cognitive performance than athletes without a history of ACL injury in inhibitory control, particularly interference control and visual attention. Therefore, rehabilitators and exercise professionals should consider the assessment and training of executive functions into the rehabilitation process for ACL injuries.
MarmuraHBryantDMGetgoodAM. Infographic. Sex differences and ACL injuries. Br J Sports Med2021; 55: 1313–1314.
2.
BodenBPSheehanFT. Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021. J Orthop Res2022; 40: 531–540.
3.
AcevedoRJRivera-VegaAMirandaG, et al.Anterior cruciate ligament injury: identification of risk factors and prevention strategies. Curr Sports Med Rep2014; 13: 186–191.
4.
LarwaJStoyCChafetzRS, et al.Stiff landings, core stability, and dynamic knee valgus: a systematic review on documented anterior cruciate ligament ruptures in male and female athletes. Int J Environ Res Public Health2021; 18: 3826.
5.
RandazzoCNelsonNGMcKenzieLB. Basketball-related injuries in school-aged children and adolescents in 1997–2007. J. Pediatr2010; 126: 727–733.
6.
KooyCEWJakobsenRBFenstadAM, et al.Major increase in incidence of pediatric ACL reconstructions from 2005 to 2021: a study from the Norwegian Knee Ligament Register. AJSM2023; 51: 2891–2899.
7.
GokelerABenjaminseADella VillaF, et al.Anterior cruciate ligament injury mechanisms through a neurocognition lens: implications for injury screening. BMJ Open Sport Exerc Med2021; 7: e001091.
8.
KrügerMHermsdörferJ. Target uncertainty during motor decision-making: the time course of movement variability reveals the effect of different sources of uncertainty on the control of reaching movements. Front Psychol2019; 10: 41.
9.
WilkeJGronebergDA. Neurocognitive function and musculoskeletal injury risk in sports: a systematic review. J Sci Med Sport2022; 25: 41–45.
10.
StephensonMLHinshawTJWadleyHA, et al.Effects of timing of signal indicating jump directions on knee biomechanics in jump-landing-jump tasks. Sports Biomech2018; 17: 67–82.
11.
McLeanSGSamorezovJE. Fatigue-induced ACL injury risk stems from a degradation in central control. Med Sci Sports Exerc2009; 41: 1661–1672.
12.
DiamondA. Executive functions. Annu Rev Psychol2013; 64: 135–168.
13.
IshiharaTMizunoM. Effects of tennis play on executive function in 6–11-year-old children: a 12-month longitudinal study. Eur J Sport Sci2018; 18: 741–752.
14.
WylieSABashoreTRVan WouweNC, et al.Exposing an “Intangible” cognitive skill among collegiate football players: enhanced interference control. Front Psychol2018; 9: 49.
BrahamRFinchCFMclntoshA, et al.Community level Australian football: a profile of injuries. J Sci Med Sport2004; 7: 96–105.
17.
SwanikCB. Brains and sprains: the brain's role in noncontact anterior cruciate ligament injuries. J Athl Train2015; 50: 1100–1102.
18.
XieLRenMCaoB, et al.Distinct brain responses to different inhibitions: evidence from a modified Flanker Task. Sci Rep2017; 7: 6657.
19.
StinsJFPoldermanJTBoomsmaDI, et al.Conditional accuracy in response interference tasks: evidence from the Eriksen flanker task and the spatial conflict task. Adv Cognit Psychol2008; 3: 409–417.
20.
JinPGeZFanT. Team ball sport experience minimizes sex difference in visual attention. Front Psychol2022; 13: 987672.
21.
FehdHMSeiffertAE. Eye movements during multiple object tracking: where do participants look?Cognition2008; 108: 201–209.
22.
PorterJMMagillRA. Systematically increasing contextual interference is beneficial for learning sport skills. J Sports Sci2010; 28: 1277–1285.
23.
WeissmanDHGopalakrishnanAHazlettC, et al.Dorsal anterior cingulate cortex resolves conflict from distracting stimuli by boosting attention toward relevant events. Cereb Cortex2005; 15: 229–237.
24.
LudygaSMückeMAndräC, et al.Neurophysiological correlates of interference control and response inhibition processes in children and adolescents engaging in open-and closed-skill sports. J Sport Health Sci2022; 11: 224–233.
25.
ChaoMZhenyuYZifanX, et al.The influence of open-skilled sports on individual’s interference inhibition abilities. Front Sport Res2023; 7: 19–24.
26.
MengF-WYaoZ-FChangEC, et al.Team sport expertise shows superior stimulus-driven visual attention and motor inhibition. PloS One2019; 14: e0217056.
27.
AkizukiKOhashiY. Measurement of functional task difficulty during motor learning: what level of difficulty corresponds to the optimal challenge point?Hum Mov Sci2015; 43: 107–117.
28.
AlmonroederTGGarciaEKurtM. The effects of anticipation on the mechanics of the knee during single-leg cutting tasks: a systematic review. IJSPT2015; 10: 918–928.
29.
WohlTRCrissCRGroomsDR. Visual perturbation to enhance return to sport rehabilitation after anterior cruciate ligament injury: a clinical commentary. IJSPT2021; 16: 552–564.
30.
KochPKrennB. Executive functions in elite athletes–comparing open-skill and closed-skill sports and considering the role of athletes’ past involvement in both sport categories. Psychol Sport Exerc2021; 55: 101925.
31.
HuijgenBCLeemhuisSKokNM, et al.Cognitive functions in elite and sub-elite youth soccer players aged 13 to 17 years. PloS One2015; 10: e0144580.
32.
ZhangDDingHWangX, et al.Enhanced response inhibition in experienced fencers. Sci Rep2015; 5: 162–182.
33.
ShuggiIMOhHShewokisPA, et al.Mental workload and motor performance dynamics during practice of reaching movements under various levels of task difficulty. Neurosci2017; 360: 166–179.
34.
DuncanJ. The multiple-demand (MD) system of the primate brain: mental programs for intelligent behaviour. Trends Cogn Sci2010; 14: 172–179.
35.
PiskinDBenjaminseADimitrakisP, et al.Neurocognitive and neurophysiological functions related to ACL injury: a framework for neurocognitive approaches in rehabilitation and return-to-sports tests. Sports Health2022; 14: 549–555.
36.
DiekfussJAGroomsDRYuanW, et al.Does brain functional connectivity contribute to musculoskeletal injury? A preliminary prospective analysis of a neural biomarker of ACL injury risk. J Sci Med Sport2019; 22: 169–174.
37.
LepleyASLyMTGroomsDR, et al.Corticospinal tract structure and excitability in patients with anterior cruciate ligament reconstruction: a DTI and TMS study. NeuroImage Clin2020; 25: 102–157.
38.
NeedleARLepleyASGroomsDR. Central nervous system adaptation after ligamentous injury: a summary of theories, evidence, and clinical interpretation. SM2017; 47: 1271–1288.
39.
RobertsDFridénTZätterströmR, et al.Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients. J Orthop Sports Phys Ther1999; 29: 587–594.
40.
KapreliEAthanasopoulosSGliatisJ, et al.Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study. AJSM2009; 37: 2419–2426.
41.
AlmonroederTGKernozekTCobbS, et al.Cognitive demands influence lower extremity mechanics during a drop vertical jump task in female athletes. J Orthop Sports Phys Ther2018; 48: 381–387.
42.
GreenAMShaikhAGAngelakiDE. Sensory vestibular contributions to constructing internal models of self-motion. J Neural Eng2005; 2: S164.
43.
ManitaSSuzukiTHommaC, et al.A top-down cortical circuit for accurate sensory perception. Neuron2015; 86: 1304–1316.
44.
Jiménez-MartínezJGutiérrez-CapoteAAlarcón-LópezF, et al.Relationship between cognitive demands and biomechanical indicators associated with anterior cruciate ligament injury: a systematic review. SM2025; 55: 145–165.
