Sensorimotor Dysfunction Following Anterior Cruciate Ligament Injury (Part 2): How Can Clinicians Rehabilitate It?

BACKGROUND: Sensorimotor dysfunction following anterior cruciate ligament (ACL) injury and subsequent ACL reconstruction (ACLR) may lead to errors in motor planning and execution. Dysfunction occurs even after athletes have completed rehabilitation. Therefore, clinicians need to implement strategies to improve how sensorimotor dysfunction is addressed during rehabilitation. CLINICAL QUESTION: How can clinicians improve their rehabilitation of sensorimotor dysfunction following ACLR? The aim of this clinical commentary is to review methods that may improve rehabilitation by targeting sensorimotor dysfunction following ACL injury. KEY RESULTS: Rehabilitation should focus on 2 priorities: (1) improving peripheral and central efferent function, and (2) improving somatosensory function and reducing reliance on the visual-motor system. CLINICAL APPLICATION: Somatosensory function can improve with proprioceptive training but should be implemented within the first 6 weeks of injury/surgery to minimize the chance of increased reliance on the visual-motor system. Methods to increase the complexity of proprioceptive training includes varying the (1) type of task (eg, jumping, decelerating, etc), (2) the visual information used during the task, (3) the cognitive loading during the task, and (4) perturbations. Visual distraction training may be useful for challenging an athlete during sports-specific training and reduce the reliance on the visual-motor system. Improving peripheral and central efferent function involves using regular cryotherapy and transcutaneous electrical nerve stimulation in the early stages to minimize pain and improve muscle recruitment. Throughout rehabilitation, strength training, neuromuscular electrical stimulation, and surface electromyography biofeedback methods improve central and peripheral efferent function when prescribed at a high intensity. J Orthop Sports Phys Ther 2025;55(7):454-462. Epub 16 May 2025. doi:10.2519/jospt.2025.12726