JORR

The Journal of Orthopedics Research and Rehabilitation welcomes scholarly papers in orthopaedic surgery, physical therapy and rehabilitation, physiotherapy, neurology and clinic anesthesiology and reanimation.

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Review
From cortex to quadriceps: understanding and treating arthrogenic muscle inhibition (AMI) after ACL injury
Arthrogenic muscle inhibition (AMI) limits voluntary quadriceps activation after anterior cruciate ligament (ACL) injury despite preserved muscle structure. This review aims to synthesize current evidence on the neurophysiopathology of AMI, measured via electroencephalography (EEG), functional magnetic resonance imaging (f-MRI), and transcranial magnetic stimulation (TMS), and on rehabilitation strategies targeting AMI. A scoping review was undertaken. A comprehensive literature search was conducted in PubMed, Web of Science, and the Cochrane Library to identify studies examining the neurophysiological mechanisms underlying AMI, and evaluating interventions aimed at restoring quadriceps function. A total of 30 studies were included in the neurophysiological basis of AMI: 11 employing EEG, 8 using f-MRI, and 11 utilizing TMS. These studies characterized the neurophysiological basis of AMI, demonstrating local joint inhibition, altered afferent signaling, cortical reorganization, and reduced corticospinal excitability, all contributing to impaired quadriceps activation. Twenty intervention studies showed that multiple strategies can enhance quadriceps activation and strength, particularly when applied early or in a phase-specific manner. Importantly, AMI is progressively reversible but leaves a subset of motoneurons difficult to recruit voluntarily, highlighting the need for interventions that specifically target the central nervous system, in addition to the muscle, to optimize neuromuscular recovery. AMI is driven by complex interactions between peripheral and central neural mechanisms, measurable via EEG, fMRI, and TMS. Early identification and targeted interventions can restore quadriceps function and mitigate long-term deficits. Understanding both neurophysiological alterations and effective therapeutic strategies is essential for designing individualized, evidence-based rehabilitation programs for ACL-injured patients.


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Volume 4, Issue 3, 2026
Page : 60-71
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