Anterior cruciate ligament tears disproportionately strike adolescent female athletes, and a substantial portion of those who undergo surgical reconstruction never return to their prior performance level. Understanding not just what movements increase risk, but how the brain encodes corrective motor learning, could transform how prevention programs are designed and monitored — making this investigation particularly timely.
In a randomized controlled design, 55 female middle- and high-school athletes (mean age ~15.7 years) completed approximately six weeks of structured neuromuscular training — three sessions per week for 18 total sessions. Within that program, participants received up to 12 sessions of either augmented visual biofeedback (real-time automated movement correction cues) or a sham biofeedback condition, allowing isolation of the biofeedback effect. Outcomes were measured via drop vertical jump assessments capturing sagittal and frontal plane hip and knee kinematics and kinetics, alongside functional MRI during a supine bilateral leg press task designed to probe sensorimotor brain regions engaged during complex lower-limb movement.
What distinguishes this trial from prior ACL prevention literature is its dual-outcome architecture: biomechanical improvement is paired with direct neuroimaging, allowing researchers to test whether central nervous system adaptations track or predict peripheral landing mechanics changes. Most prior neuromuscular training studies have treated the brain as a black box, inferring motor learning from biomechanical output alone. Mapping task-related sensorimotor cortex and cerebellar activity alongside movement data is a meaningful methodological step forward.
Key limitations include the adolescent female-only sample, constraining generalizability, and the relatively short six-week intervention window. The sham biofeedback control is methodologically sound but does not eliminate expectation effects entirely. Whether neuroimaging changes persist beyond the training period remains unknown. Overall, this trial is incrementally important — it does not overturn existing prevention paradigms but meaningfully advances mechanistic understanding of how targeted training reshapes the neuromuscular system from the cortex downward.
