Neuromuscular Performance Varies with Baseline Neurocognition: Implications for Anterior Cruciate Ligament Injury Risk and Prevention

BACKGROUND: Neurocognitive performance may be a risk factor for anterior cruciate ligament injury, and may influence risk via changes in neuromuscular performance; however, there are no existing data the relationship between neurocognition and neuromuscular performance during complex athletic tasks. Hypothesis: Athletes with low baseline neurocognitive performance would demonstrate worse neuromuscular performance during the completion of an unanticipated jump landing task compared to athletes with high baseline neurocognitive performance. STUDY DESIGN: Controlled laboratory study. METHODS: 3-dimensional kinematic and kinetic data of the dominant limb were collected for 37 recreational athletes while performing an unanticipated jump landing task. Subjects were screened using a computer-based neurocognitive test into high (HP) and low (LP) performing groups (HP=20, LP=17). The task consisted of a forward jump onto a force plate with an immediate jump to a second target that was assigned 250msec prior to landing on the force plate. Kinematic and kinetic data were obtained during the first jump landing. RESULTS: The LP group (Mean±SD of LP vs HP) demonstrated significantly altered neuromuscular performance during the landing phase while completing the jump landing task, including significantly increased peak vertical ground reaction force (1.81±0.53BW vs 1.38±0.37BW, p<0.01), peak anterior tibial shear force (0.91±0.17BW vs 0.72±0.22BW, p<0.01), knee abduction moment (0.47±0.56BW*BH vs 0.03±0.64BW*BH, p=0.03), and knee abduction angle (6.1±4.7o vs 1.3±5.6o, p=0.03), and well as decreased trunk flexion angle (9.6±9.6o vs 16.4±11.2o, p<0.01). CONCLUSION: Athletes with lower levels of baseline neurocognition possess worse neuromuscular performance during a challenging jump landing task. CLINICAL RELEVANCE: Neurocognitive testing and neuromuscular assessment during dual-attention conditions may improve anterior cruciate ligament injury risk screening, while incorporating neurocognitive challenges into neuromuscular-based training programs may improve injury prevention and rehabilitation.