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Abdollahi S, Anbarian M, Sheikhhoseini R. Neuromuscular Interactions and Interlimb Asymmetry in Athletes Following Hamstring Graft Anterior Cruciate Ligament Reconstruction. PTJ 2026; 16 (4) :393-408
URL: http://ptj.uswr.ac.ir/article-1-887-en.html

Purpose: Persistent neuromuscular deficits following anterior cruciate ligament reconstruction (ACLR) have been linked to alterations in central neural drive and disrupted corticomuscular communication. This study aimed to investigate corticomuscular interactions and neuromuscular control during a steady force task in athletes following ACLR compared to healthy athletes.
Methods: Twenty-four male athletes participated in this cross-sectional study, including 12 athletes who underwent unilateral ACLR using a hamstring tendon autograft and 12 uninjured healthy athletes. Athletes in the ACLR group were tested 10.0±2.0 months post-surgery. Participants performed a standardized steady isometric force task. Cortical activity was recorded using electroencephalography (EEG), and surface electromyography (EMG) was recorded from the semitendinosus muscle. Corticomuscular coherence was calculated in the beta (13–30 Hz) and gamma (30–60 Hz) frequency bands. Force steadiness was quantified using the coefficient of variation of force (ForceCV), and inter-limb asymmetry was assessed using a functional asymmetry ratio.
Results: The ACLR and Healthy groups did not differ in age, height, body mass, or body mass index (P>0.05). Force steadiness was significantly reduced in the ACLR group, with higher ForceCV values than in healthy athletes (4.5±0.7% vs 3.0±0.7%, P<0.001, d=2.14). Corticomuscular coherence analysis revealed limb-specific alterations in the ACLR group, particularly in the beta-band, where coherence tended to be lower in the reconstructed limb than in the contralateral limb. Healthy athletes demonstrated near-symmetrical coherence between dominant and non-dominant limbs. A similar but smaller pattern was observed in the gamma band. Inter-limb functional asymmetry was significantly greater in the ACLR group (1.30±0.11) than in the healthy group (1.00±0.11; P<0.001, d=2.73). ForceCV was strongly correlated with the functional asymmetry ratio across all participants (r=0.99, P<0.001).
Conclusion: Following ACLR, athletes exhibit altered corticomuscular interactions, reduced force steadiness, and greater inter-limb asymmetry during a controlled force task. These findings indicate that persistent neuromuscular deficits after ACLR may involve disrupted neuromuscular coupling between the central nervous system and peripheral musculature. Therefore, rehabilitation strategies targeting both neuromuscular control and central neural mechanisms may be important for restoring symmetrical motor function after ACL reconstruction.