Decreased kinesiophobia with virtual embodiment for post-surgical knee rehabilitation

Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ACL reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. The VR group performed a 20-minute daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (IKDC), quadriceps strength, knee joint range of motion (ROM), and kinesiophobia (TSK-11) were measured at baseline, 4, 12, and 36 weeks. Statistical analysis involved RM-ANOVA to evaluate treatment effects. A total of 47 patients were recruited, with 44 completing the study. The VR group had a significant reduction in kinesiophobia at 4 weeks post-surgery (p=0.043), with a mean reduction of 4.8 points compared to controls. No significant differences were found for self-reported disability, range of motion, or quadriceps strength. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery.