Anterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups.

Eighteen participants with left knee ACLR and 18 control participants performed a knee flexion/extension motor control task during functional magnetic resonance imaging (fMRI). A conjunction analysis was conducted to determine the degree of overlap in brain activity for involved and uninvolved limb knee motor control between groups.

The ACLR group had a statistically higher mean percent signal change in the sensorimotor cortex for the involved > uninvolved contrast compared to the control group. Brain activity between groups statistically overlapped in sensorimotor regions of the cortex and cerebellum for both group contrasts: involved > uninvolved and uninvolved > involved. Relative to the control group, the ACLR group uniquely activated superior parietal regions (precuneus, lateral occipital cortex) for involved limb motor control. Additionally, for involved limb motor control, the ACLR group displayed a medial and superior shift in peak voxel location in frontal regions; for parietal regions, the ACLR group had a more posterior and superior peak voxel location relative to the control group.

ACLR may result in unique activation of the sensorimotor cortex via a cortically driven sensory integration strategy to maintain involved limb motor control. The ACLR group's unique brain activity was independent of strength, self-reported knee function, and time from surgery.