The Role of Neuroplasticity in Pain and Fear of Re-Injury Following ACL Reconstruction

Motivation: ACLR patients often struggle with pain and fear of re-injury, hindering their return to sports. The underlying neural mechanisms are unclear. Goal(s): This study aimed to investigate brain structural and functional changes related to pain and kinesiophobia in ACLR patients using MRI. Approach: Thirty-six ACLR patients and 36 controls underwent structural and resting-state fMRI to examine gray matter volumes and functional connectivity in pain-related regions. Results: Reductions in gray matter volume and functional connectivity were observed in ACLR patients. Mediation analysis revealed that pain influenced psychological readiness through PAG-ACC connectivity, suggesting central mechanisms for pain and kinesiophobia. Impact: The study reveals that peripheral nociceptive input alters brain structure and function in ACLR patients, emphasizing the critical need for targeted neuropsychological interventions alongside comprehensive physical rehabilitation to improve pain management and return-to-sport success.