REWIRING THE INJURED KNEE: CORTICAL REORGANISATION, MOTOR ENGRAMS, AND THE NEUROBIOLOGY OF RETURN-TO-SPORT SYMMETRY AFTER ACL INJURY- A CONCEPTUAL REVIEW

Anterior Cruciate Ligament (ACL) injury precipitates not only peripheral structural damage but also central neuroplastic reorganisation. Disrupted afferent input alters sensorimotor integration, reduces corticospinal excitability, and destabilises motor engrams governing quadriceps activation and dynamic knee control. These cortical adaptations manifest as persistent arthrogenic inhibition and functional asymmetry despite successful reconstruction. Therefore, effective rehabilitation must integrate neural restoration with tissue healing to achieve true limb symmetry and safe return to sport. Recent research shows that ACL rupture disrupts motor engrams—the brain’s stored movement patterns responsible for quadriceps activation, proprioception, and dynamic knee stability. These cortical changes contribute to quadriceps inhibition, altered gait, and delayed functional recovery even after successful reconstruction. Therefore, ACL rehabilitation must target both tissue healing and the restoration of disrupted neural pathways. AIM: To explore how motor engram disruption and cortical reorganisation influences recovery after ACL injury and to propose a neuro-integrative rehabilitation as an evidence-supported neuroplasticity technique that can facilitate brain-based rehabilitation and functional symmetry and safe return to sport.

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