Fear of reinjury matters after ACL injury

Abstract

Purpose Fear of re-injury has been linked to functional joint instability after an anterior cruciate ligament injury. However, it is still unknown how fear and function are linked sequentially in patients with a knee sprain. Therefore, the purpose of this narrative review article was to provide a comprehensive summary of the interrelationships between neuromuscular control, cognition, and emotion, the neural mechanisms underlying cognitive and emotional regulation processes, and potential emotional regulatory training after knee ligamentous injury. Methods Previous research articles and more relevant research articles through a cited reference emphasizing fear of re-injury, cognition, emotion, neuromuscular control, and anterior cruciate ligament injury searched from PubMed databases were reviewed. Results Higher fear of re-injury in patients after an anterior cruciate ligament (ACL) injury may be associated with diminished neuromuscular control. As negative emotion requires better cognitive neural processing in the several brain’s regions that are also essential for maintaining dynamic joint stability, increased neural demands as a result of higher fear of re-injury can disrupt neuromuscular control and long-term pathological sequalae. Therefore, enhanced neural efficiency in cognitive control networks through executive function training may help ACL patients to regulate high fear of re-injury and dynamic restraint systems to maintain functional joint stability during intense physical activity. Conclusions As negative feelings can interfere with the cognitive processing for neuromuscular control, executive function training may improve affective control and muscle coordination. Understanding the interrelationships that exist between neuromuscular control, cognition and emotion help to not only develop better rehabilitation program, but also improve patient outcomes after an anterior cruciate ligament injury.