Mental Imagery for Anterior Cruciate Ligament Reconstruction

Overseen By Allison S Hyngstrom, PT, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Marquette University

Disqualifiers: Neurological condition, Substance abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

20 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if mental imagery exercises can aid in regaining leg strength after ACL reconstruction surgery. Participants will perform mental exercises at home, imagining movements like squats or leg extensions, for five days while undergoing physical therapy. Researchers seek to understand if these mental exercises can enhance leg strength during recovery. Ideal candidates for the trial have recently undergone ACL surgery and are currently in physical therapy. As an unphased trial, this study provides participants the chance to explore innovative recovery techniques that may enhance their rehabilitation experience.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that mental imagery exercises are safe for ACLR recovery?

Research has shown that mental imagery exercises are generally safe for individuals recovering from ACL surgery. Studies have found that imagining movements like leg extensions, known as open kinetic chain (OKC) exercises, can be beneficial without causing harm during early recovery. This suggests that imagining these exercises is also likely safe.

For closed kinetic chain (CKC) exercises, such as imagining squats, combining imagery training with physical therapy can help reduce fear of reinjury and pain. This indicates that these exercises are safe and may offer psychological benefits.

Overall, the mental imagery exercises in this trial are non-invasive and have shown promise in similar situations, suggesting they are likely safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these mental imagery techniques for ACL reconstruction recovery because they offer a non-invasive, accessible approach to rehabilitation. Unlike traditional physical therapy, which requires physical exertion and professional supervision, these treatments rely on the power of mental visualization to simulate exercises, potentially enhancing muscle memory and neural connections. The Mental Imagery Open Chain technique focuses on imagining seated leg extensions, while the Closed Chain technique involves visualizing standing squats, both aiming to improve recovery outcomes without physical strain. This innovative method could be especially beneficial for patients who are temporarily unable to perform physical exercises due to pain or other limitations.

What evidence suggests that this trial's mental imagery exercises could be effective for ACLR recovery?

Research shows that mental imagery exercises can aid recovery after ACL surgery. Some studies have found that these exercises can strengthen muscles and reduce pain post-operation. In this trial, participants will engage in either open chain or closed chain mental imagery exercises. Imagining these exercises might improve leg strength and function. While research continues, early results suggest that mental imagery could enhance recovery compared to standard rehabilitation alone. ^{1 5 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals who have had anterior cruciate ligament reconstruction (ACLR) surgery, are cleared and currently in physical therapy. It's not suitable for those with neurological issues affecting muscle strength, substance abuse history within 5 years, uncontrolled medical conditions, inability to follow simple commands, or if they're over 9 months post-surgery.

Inclusion Criteria

I am approved to join physical therapy.

I am currently in physical therapy for ACL reconstruction.

I have had ACL reconstruction surgery.

Exclusion Criteria

History of substance abuse in the last 5 years

I have lower back or hip pain that affects my ability to move my legs.

I have a neurological condition that affects my muscle strength.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Testing

Participants undergo initial testing sessions to measure leg function, including knee range of motion and knee extension strength

1 day

1 visit (in-person)

Mental Imagery Intervention

Participants complete mental imagery exercises for 10 minutes once per day for five days at home, focusing on either open or closed chain exercises

5 days

5 sessions (home-based)

Post-Intervention Testing

Participants undergo post-intervention testing sessions to measure changes in leg function, including knee range of motion and knee extension strength

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any long-term effects or changes in leg strength and function after the intervention

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Mental Imagery Closed Chain
• Mental Imagery Open Chain

Trial Overview The study tests whether mental imagery exercises can boost leg strength during ACL recovery. Participants will do daily mental imagery related to leg movements for five days and track their completion while attending two sessions measuring leg function.

How Is the Trial Designed?

Group I: Mental Imagery Open Chain Experimental Treatment 1 Intervention

Participants will receive a paper packet with instructions to imagine themselves performing seated maximal leg extension exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.

Group II: Mental Imagery Closed Chain Experimental Treatment 1 Intervention

Participants will receive a paper packet with instructions to imagine themselves performing maximal standing squat exercises. They will be instructed to imagine the feeling of the exercise for 5 seconds, rest for 5 seconds, and repeat this 50 times with a 2-minute rest period after the 25th repetition. They will also be asked to keep track of the exercises with tallies on a table within the packet and also to record on this table if they did not complete the exercises for that day. The participant is asked to perform the exercises on five consecutive days.

Who Is Running the Clinical Trial?

Marquette University

Lead Sponsor

Trials

68

Recruited

202,000+

Published Research Related to This Trial

In a study of 155 patients recovering from ACL reconstruction, higher levels of Neuroticism were linked to poorer knee function and balance outcomes at 3 and 6 months post-surgery, indicating that psychological traits can significantly impact rehabilitation.

Conversely, higher Conscientiousness scores were associated with better knee function and balance, suggesting that personality traits can be considered when creating personalized rehabilitation plans for patients after ACL surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of personality traits on rehabilitation effect after anterior cruciate ligament reconstruction: An observational study. Xu, Y., Cai, HM., Yang, WT., et al.[2022]

The study found that a guided imagery intervention, when combined with standard rehabilitation, significantly improved knee laxity in patients six months after anterior cruciate ligament repair, compared to standard rehabilitation alone.

While the imagery intervention did not show a difference in knee strength or self-efficacy, it positively influenced neurohormonal factors like noradrenaline and dopamine, suggesting potential mechanisms for enhanced recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. Maddison, R., Prapavessis, H., Clatworthy, M., et al.[2022]

Motor imagery (MI) interventions after anterior cruciate ligament (ACL) reconstruction showed mixed results in clinical outcomes such as pain, anxiety, and function, based on a systematic review of six studies.

While some studies indicated potential benefits in muscle activation and strength, the overall evidence was inconclusive and based on small sample sizes, highlighting the need for larger, long-term randomized controlled trials to better assess the effectiveness of MI in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review. Pastora-Bernal, JM., Estebanez-Pérez, MJ., Lucena-Anton, D., et al.[2021]

In a study of 149 patients who underwent ACL reconstruction, MRI assessments of graft signal (using SNQ and Howell scores) did not correlate with functional outcomes or knee stability two years post-surgery.

The findings suggest that MRI appearances of ACL grafts may not be reliable indicators of graft maturity or recovery, indicating a need for alternative methods to evaluate graft healing and readiness for return to sports.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two-year postoperative MRI appearances of anterior cruciate ligament hamstrings autografts are not correlated with functional outcomes, anterior laxity, or patient age. Bouguennec, N., Robinson, J., Douiri, A., et al.[2021]

In a study of 23 patients after anterior cruciate ligament reconstruction, the oblique axial MRI images were found to be particularly useful for assessing the integrity of the reconstructed ligament, showing no evidence of rupture despite some discontinuity observed in other imaging planes.

The reconstructed graft increased in diameter by 70% over the year following surgery, and there was a noted increase in signal intensity, indicating positive healing, while also highlighting the importance of adequate notchplasty to prevent graft impingement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Magnetic resonance imaging of reconstructed anterior cruciate ligament. Min, BH., Chung, WY., Cho, JH.[2022]

Imagery training, when combined with standard physical therapy, effectively reduces fear of reinjury and pain perception in athletes recovering from anterior cruciate ligament reconstruction, addressing a significant psychological barrier to returning to sports.

Research indicates that fear of reinjury is a major predictor of whether athletes return to competitive activity, highlighting the importance of incorporating psychological strategies like imagery into rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training. Rodriguez, RM., Marroquin, A., Cosby, N.[2019]

Motor imagery (MI) significantly increased muscle activation in the quadriceps of 12 patients recovering from anterior cruciate ligament (ACL) surgery, suggesting it can enhance rehabilitation outcomes.

Despite not reducing pain, MI effectively supports muscle recovery and motor function, indicating its potential as a valuable addition to traditional physiotherapy in ACL rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increased muscle activation following motor imagery during the rehabilitation of the anterior cruciate ligament. Lebon, F., Guillot, A., Collet, C.[2022]

Combining mental imagery with physical practice can enhance strength performance, and mental imagery alone can help prevent strength loss during short-term immobilization, such as after ACL injuries.

Internal mental imagery is significantly more effective for improving muscle strength than external imagery, with effects mediated by factors like motivation and self-efficacy, and linked to neural adaptations and increased muscle activation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Mental Imagery on Muscular Strength in Healthy and Patient Participants: A Systematic Review. Slimani, M., Tod, D., Chaabene, H., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7866187/

The Effectiveness and Recommendation of Motor Imagery ... The main objective of this study was to analyze the effectiveness of MI interventions after anterior cruciate ligament (ACL) reconstruction.

2. oatext.com oatext.com/the-effectiveness-of-mental-imagery-exercises-as-a-neurocognitive-based-approach-after-aclr-a-systematic-review.php

The effectiveness of mental imagery exercises as a ... ... reconstruction, mental imagery, motor imagery, mental ... Guided imagery to improve functional outcomes post-anterior cruciate ligament repair.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11569572/

Impact of Psychological Factors on Rehabilitation After ... Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase ...

4. researchgate.net researchgate.net/profile/Hussein-Ziab/publication/344209126_The_effectiveness_of_mental_imagery_exercises_as_a_neurocognitive-based_approach_after_ACLR_A_systematic_review/links/5f5bc3ed4585154dbbc9add4/The-effectiveness-of-mental-imagery-exercises-as-a-neurocognitive-based-approach-after-ACLR-A-systematic-review.pdf

The-effectiveness-of-mental-imagery-exercises-as-a- ... Conclusion: In conclusion, the effectiveness of mental imagery exercise after Anterior Cruciate Ligament Reconstruction could be considered as ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S2666061X24002050

Most Patients Report Acceptable Knee Function, ... Purpose. To describe the long-term outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps-free tendon autograft (QFT) in terms of ...

6. frontiersin.org frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2024.1416690/full

Effect of open vs. closed kinetic chain exercises in ACL ... OKC exercises appear to be superior to CKC for improving quadriceps strength 3–4 months post-injury, whether as a part of conservative or post-surgery ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2059775422000943

Rehabilitation following surgical reconstruction for anterior ... This article discusses how postoperative rehabilitation following ACLR has changed from the 1960s to now, focussing on surgical technique (type of tendon graft, ...

8. journals.humankinetics.com journals.humankinetics.com/view/journals/jsr/28/4/article-p385.xml

Reducing Fear of Reinjury and Pain Perception in Athletes ... Imagery training in combination with standard physical therapy is a suitable option to reduce the fear of reinjury and pain perception among first-time ...