Previous Knee Injury Alters Bilateral Supraspinal Excitability During Torque Control: An Exploratory Study
Abstract
Background: Knee ligament and meniscal injuries may cause persistent neuromuscular alterations despite successful return to sport (RTS). However, whether previous knee injury affects supraspinal excitability during torque control remains unclear. This observational study investigated the association between previous knee ligament or meniscal injury and supraspinal excitability in female university basketball players using long-latency reflexes (LLRs).
Methods: Nineteen athletes participated, including five with a history of knee injury who had completed rehabilitation and returned to sport. During a sustained knee extension task at 25% of maximal voluntary isometric contraction, LLR characteristics (appearance rate, latency, duration, LLR/Mmax ratio, and phase count) were recorded from the ipsilateral opponens pollicis muscle. Comparisons were made between injured and non-injured limbs, between dominant and non-dominant limbs, and between the injured limbs of previously injured athletes and the dominant limbs of healthy athletes.
Results: Healthy athletes demonstrated significantly shorter latency and greater LLR duration, LLR/Mmax ratio, and phase count in the dominant limb than in the non-dominant limb (p < .05). In contrast, no significant interlimb or dominance-related differences were observed in athletes with previous knee injury. Compared with the dominant limbs of healthy athletes, the injured limbs of previously injured athletes exhibited significantly prolonged LLR latency.
Conclusion: These findings suggest that previous knee ligament or meniscal injury is associated with bilateral alterations in supraspinal neuromuscular control and delayed supraspinal processing during torque control. LLR assessment may complement conventional RTS evaluations by providing objective neurophysiological information relevant to safer RTS decision-making.
Keywords: Long-latency reflex, neuromuscular control, knee injury, sports
References
Çabuk, H., Kuşku Çabuk, F., & Turan, K. (2022). The time from injury to surgery is an important factor affecting the mechanoreceptors at stump of torn anterior cruciate ligament. Archives of Orthopaedic and Trauma Surgery, 142(11), 3389–3393. https://doi.org/10.1007/s00402-021-04310-3
Conrad, B., & Aschoff, J. C. (1977). Effects of voluntary isometric and isotonic activity on late transcortical reflex components in normal subjects and hemiparetic patients. Electroencephalography and Clinical Neurophysiology, 42(1), 107–116. https://doi.org/10.1016/0013-4694(77)90155-9
Daikuya, S., & Okayama, Y. (2018). Opponens pollicis silent period during a precision motor task with the isometric contraction of the ipsilateral knee extension. International Journal of Applied Exercise Physiology, 7(2), 9–14.
Daikuya, S., Okayama, Y., & Yabe, K. (2017). Opponens pollicis long latency reflex during the ipsilateral sustained knee torque maintenance. Journal of Athletic Enhancement, 6(5), Article 1000271. https://doi.org/10.4172/2324-9080.1000271
Drigny, J., Rolland, M., Remilly, M., Guermont, H., Reboursière, E., Hulet, C., & Gauthier, A. (2025). Knee proprioception four months after anterior cruciate ligament reconstruction: Impact of limb dominance, anterolateral procedure, and association with readiness to return to sport. Physical Therapy in Sport, 71, 61–68. https://doi.org/10.1016/j.ptsp.2024.11.005
Fleming, J. D., Ritzmann, R., & Centner, C. (2022). Effect of an anterior cruciate ligament rupture on knee proprioception within 2 years after conservative and operative treatment: A systematic review with meta-analysis. Sports Medicine, 52(5), 1091–1102. https://doi.org/10.1007/s40279-021-01600-z
Furlanetto, T. S., Peyré-Tartaruga, L. A., do Pinho, A. S., Bernardes, E. da S., & Zaro, M. A. (2016). Proprioception, body balance and functionality in individuals with ACL reconstruction. Acta Ortopédica Brasileira, 24(2), 67–72. https://doi.org/10.1590/1413-785220162402108949
Gokeler, A., Welling, W., Zaffagnini, S., Seil, R., & Padua, D. (2017). Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 25(1), 192–199. https://doi.org/10.1007/s00167-016-4246-3
Kennedy, J. C., Alexander, I. J., & Hayes, K. C. (1982). Nerve supply of the human knee and its functional importance. American Journal of Sports Medicine, 10(6), 329–335. https://doi.org/10.1177/036354658201000601
Kim, H. J., Lee, J. H., & Lee, D. H. (2017). Proprioception in patients with anterior cruciate ligament tears: A meta-analysis comparing injured and uninjured limbs. American Journal of Sports Medicine, 45(12), 2916–2922. https://doi.org/10.1177/0363546516682231
Kyritsis, P., Bahr, R., Landreau, P., Miladi, R., & Witvrouw, E. (2016). Likelihood of ACL graft rupture: Not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50(15), 946–951. https://doi.org/10.1136/bjsports-2015-095908
Laboute, E., Verhaeghe, E., Ucay, O., & Minden, A. (2019). Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes. Journal of Experimental Orthopaedics, 6(1), Article 6. https://doi.org/10.1186/s40634-019-0174-8
Losciale, J. M., Zdeb, R. M., Ledbetter, L., Reiman, M. P., & Sell, T. C. (2019). The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 49(2), 43–54. https://doi.org/10.2519/jospt.2019.8190
Majewski, M., Susanne, H., & Klaus, S. (2006). Epidemiology of athletic knee injuries: A 10-year study. The Knee, 13(3), 184–188. https://doi.org/10.1016/j.knee.2006.01.005
Marsden, C. D., Merton, P. A., & Morton, H. B. (1973). Is the human stretch reflex cortical rather than spinal? The Lancet, 301(7816), 759–761. https://doi.org/10.1016/s0140-6736(73)92141-7
Neto, T., Sayer, T., Theisen, D., & Mierau, A. (2019). Functional brain plasticity associated with ACL Injury: A scoping review of current evidence. Neural Plasticity, 2019, Article 3480512. https://doi.org/10.1155/2019/3480512
Okayama, Y., & Daikuya, S. (2023). Surface electromyography of lower extremity muscles during sustained isometric knee extension compared with a difference of the feedback method. Asian Exercise & Sport Science Association, 7, 23–28.
Okayama, Y., & Daikuya, S. (2025). Proprioception and central nervous excitability: Implications for return-to-play in athletes with ligament or meniscal injuries. International Journal of Sports Physical Therapy, 20(8), 1122–1130. https://doi.org/10.26603/001c.142068
Palmer, E., & Ashby, P. (1992). Evidence that a long latency stretch reflex in humans is transcortical. The Journal of Physiology, 449, 429–440. https://doi.org/10.1113/jphysiol.1992.sp019094
Paschos, N. K., & Howell, S. M. (2017). Anterior cruciate ligament reconstruction: Principles of treatment. EFORT Open Reviews, 1(11), 398–408. https://doi.org/10.1302/2058-5241.1.160032
Promsri, A., Bangkomdet, K., Jindatham, I., & Jenchang, T. (2023). Leg dominance–surface stability interaction: Effects on postural control assessed by smartphone accelerometry. Sports, 11(4), Article 75. https://doi.org/10.3390/sports11040075
Rodriguez, K. M., Palmieri-Smith, R. M., & Krishnan, C. (2021). How does anterior cruciate ligament reconstruction affect the functioning of the brain and spinal cord? A systematic review with meta-analysis. Journal of Sport and Health Science, 10(2), 172–181. https://doi.org/10.1016/j.jshs.2020.07.005
Strong, A., Grip, H., Boraxbekk, C.-J., Selling, J., & Häger, C. K. (2022). Brain response to a knee proprioception task among persons with anterior cruciate ligament reconstruction and controls. Frontiers in Human Neuroscience, 16, Article 841874. https://doi.org/10.3389/fnhum.2022.841874
van Melick, N., van Cingel, R. E. H., Brooijmans, F., Neeter, C., van Tienen, T., Hullegie, W., & Nijhuis-van der Sanden, M. W. G. (2016). Evidence-based clinical practice update: Practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British Journal of Sports Medicine, 50(24), 1506–1515. https://doi.org/10.1136/bjsports-2015-095898
Velotta, J., Weyer, J., Ramirez, A., Winstead, J., & Bahamonde, R. (2011). Relationship between leg dominance tests and type of task. Portuguese Journal of Sport Sciences, 11(Suppl. 2), 1035–1038.
Waldén, M., Hägglund, M., Magnusson, H., & Ekstrand, J. (2016). ACL injuries in professional football: A 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. British Journal of Sports Medicine, 50(12), 744–750. https://doi.org/10.1136/bjsports-2015-095952
Xergia, S. A., Pappas, E., Zampeli, F., Georgiou, S., & Georgoulis, A. D. (2013). Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction. Journal of Orthopaedic & Sports Physical Therapy, 43(3), 154–162. https://doi.org/10.2519/jospt.2013.3967
Xu, C., Liu, T., Wang, M., Liu, C., Li, B., Lian, Q., Chen, T., Chen, F., Qiao, S., & Wang, Z. (2022). Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft. BMC Musculoskeletal Disorders, 23(1), Article 1056. https://doi.org/10.1186/s12891-022-06019-9
Zhou, M., Gu, L., Chen, Y., Yu, C., Ao, Y., Huang, H., & Yang, Y. (2008). Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction. Chinese Medical Journal, 121(22), 2224–2228.
Zimny, M. L., Albright, D. J., & Dabezies, E. (1988). Mechanoreceptors in the human medial meniscus. Acta Anatomica, 133(1), 35–40. https://doi.org/10.1159/000146611
Zimny, M. L., Schutte, M., & Dabezies, E. (1986). Mechanoreceptors in the human anterior cruciate ligament. Anatomical Record, 214(2), 204–209. https://doi.org/10.1002/ar.1092140216
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Author(s). Published by Lithuanian Sports University.
This work is licensed under a Creative Commons Attribution 4.0 International License.
