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The Relationship Between Neurocognitive Function and Noncontact Anterior Cruciate Ligament Injuries

Charles Buz Swanik, PhD, ATC^,*, Tracey Covassin, PhD, ATC, David J. Stearne, PhD, ATC and Philip Schatz, PhD^||

From the Department of Health, Nutrition & Exercise Science, University of Delaware, Newark, Delaware, Department of Kinesiology, Michigan State University, East Lansing, Michigan, Department of Kinesiology, West Chester University, West Chester, Pennsylvania, and the ^|| Department of Psychology, Saint Joseph’s University, Philadelphia, Pennsylvania

^* Address correspondence to Charles Buz Swanik, PhD, ATC, University of Delaware, Department of Health, Nutrition & Exercise Science, Biomechanics and Movement Sciences Program, 151 Human Performance Laboratory, 542 South College, Newark, DE 19716 (e-mail: cswanik{at}udel.edu).

Background: Biomechanical analyses suggest that the loss of neuromuscular control is associated with noncontact anterior cruciate ligament sprains; however, previous research has not explored the link between neurocognitive function and unintentional knee injuries.

Purpose: To determine if athletes who suffer a noncontact anterior cruciate ligament injury demonstrate decreased baseline neurocognitive performance when compared with matched controls.

Study Design: Case control study; Level of evidence, 3.

Methods: The baseline scores from a computerized neurocognitive test battery (ImPACT) were analyzed to compare verbal memory, visual memory, processing speed, and reaction time. Eighty intercollegiate athletes who, subsequent to testing, experienced noncontact anterior cruciate ligament injuries, were matched with 80 controls based on height, weight, age, gender, sport, position, and years of experience at the collegiate level.

Results: Statistical differences were found between the noncontact anterior cruciate ligament injury group and the matched controls on all 4 neurocognitive subtests. Noncontact anterior cruciate ligament–injured athletes demonstrated significantly slower reaction time (F_1,158 = 9.66, P = .002) and processing speed (F_1,158 = 12.04, P = .001) and performed worse on visual (F_1,158 = 19.16, P = .000) and verbal memory (F_1,158 = 4.08, P = .045) composite scores when compared with controls.

Conclusion: Neurocognitive differences may be associated with the loss of neuromuscular control and coordination errors, predisposing certain intercollegiate athletes to noncontact anterior cruciate ligament injuries.

Key Words: neuropsychological functioning • ImPACT • knee • neuromuscular

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