Immersive virtual reality improves movement patterns in patients after ACL reconstruction: implications for enhanced criteria-based return-to-sport rehabilitation

The purpose of this study was to evaluate the influence of immersion in a virtual reality environment on knee biomechanics in patients after ACL reconstruction (ACLR). It was hypothesized that virtual reality techniques aimed to change attentional focus would influence altered knee flexion angle, knee extension moment and peak vertical ground reaction force (vGRF) in patients following ACLR. Twenty athletes following ACLR and 20 healthy controls (CTRL) performed a step-down task in both a non-virtual reality environment and a virtual reality environment displaying a pedestrian traffic scene. A motion analysis system and force plates were used to measure kinematics and kinetics during a step-down task to analyse each single-leg landing. A significant main effect was found for environment for knee flexion excursion (P = n.s.). Significant interaction differences were found between environment and groups for vGRF (P = 0.004), knee moment (P < 0.001), knee angle at peak vGRF (P = 0.01) and knee flexion excursion (P = 0.03). There was larger effect of virtual reality environment on knee biomechanics in patients after ACLR compared with controls. Patients after ACLR immersed in virtual reality environment demonstrated knee joint biomechanics that approximate those of CTRL. The results of this study indicate that a realistic virtual reality scenario may distract patients after ACLR from conscious motor control. Application of clinically available technology may aid in current rehabilitation programmes to target altered movement patterns after ACLR. Diagnostic study, Level III.