Does brain functional connectivity contribute to musculoskeletal injury? A preliminary prospective analysis of a neural biomarker of ACL injury risk

Abstract

Objectives: We aimed to present a unique prospective neurological dataset for participants who experienced an ACL injury.

Design: Prospective longitudinal case-control.

Methods: High school female soccer athletes were evaluated using functional magnetic resonance imaging to capture resting-state brain connectivity prior to their competitive season. Two of these athletes later experienced an ACL injury (ACLI). We matched these ACLI participants with eight teammates who did not go on to sustain an ACL injury (uninjured controls, Con) based on age, grade, sex, height, and weight to examine differences in preseason connectivity. Knee-motor regions of interest (ROIs) were created based on previously published data from which five specific areas were selected as seeds for analysis. Independent-samples t-tests with a false discovery rate correction for multiple comparisons determined differences in connectivity between the ACLI and Con.

Results: There was significantly greater connectivity between the left primary sensory cortex (a brain region responsible for proprioception) and the right posterior lobe of the cerebellum (a brain region responsible for balance and coordination) for the Con relative to ACLI, t (8)=4.53, p=0.03 (false discovery rate corrected).

Conclusions: These preliminary data indicate that those who do not later sustain an ACL injury exhibit a stronger functional connection between a cortical sensory-motor region and a cerebellar region responsible for balance and coordination. These findings may help to guide development of brain-driven biofeedback training that optimizes and promotes adaptive neuroplasticity to reduce motor coordination errors and injury risk.

Keywords: Central nervous system; Knee; Musculoskeletal injury; Resting-state fMRI.

Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1:

Each panel corresponds to individual subject connectivity data between the left primary sensory cortex and right posterior lobe of the cerebellum. There was significantly greater connectivity for the eight control participants relative to two participants who later experienced an ACL rupture (shaded gray),t (8) = 4.57, p = 0.04. U= 0.0, p = 0.04. R values are Fisher transformed Pearson correlation coefficients between the average residual BOLD time series of pairs of regions of interest. The y-axis is the BOLD signal and the x-axis is volumes.