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?

The goal of this clinical trial is to understand if people recovering from anterior cruciate ligament reconstruction (ACLR) surgery will complete mental imagery training and if this will improve their injured leg's strength. The main questions are: * Will people complete a five-day mental imagery exercise schedule while in physical therapy for ACLR? * Does mental imagery exercise help raise leg strength during ACLR recovery? Researchers will also compare if different mental imagery exercises involving leg extension or squats will change leg strength. Participants will be asked to: * Participate in two testing sessions to make measurements of leg function * Complete about 10 minutes of mental imagery exercises once per day for five days at home and write down whether they complete the exercises.

Will I have to stop taking my current medications?

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

Is mental imagery safe for use in humans?

Mental imagery, used alongside physical therapy, has been shown to be safe and can help reduce anxiety, tension, and pain, while promoting healing in patients recovering from anterior cruciate ligament reconstruction. ^{1 2 3 4 5}

How does mental imagery treatment differ from other treatments for ACL reconstruction?

Mental imagery treatment is unique because it focuses on the psychological aspects of recovery, helping to reduce fear of reinjury and pain perception, which are often overlooked in traditional physical therapy. This treatment involves visualizing performing skills in the mind, which can aid in reducing anxiety and promoting healing, unlike standard physical rehabilitation that primarily addresses physical recovery. ^{1 2 6 7 8}

What data supports the effectiveness of the treatment Mental Imagery Closed Chain, Mental Imagery Open Chain for Anterior Cruciate Ligament Reconstruction?

Research suggests that mental imagery, when combined with standard physical therapy, can help reduce fear of reinjury and pain perception in patients recovering from anterior cruciate ligament reconstruction. Additionally, mental imagery has been shown to increase muscle activation and may aid in the recovery of muscle strength, making it a potentially useful addition to rehabilitation programs. ^{1 2 3 4 5}

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

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]

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]

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]

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]

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 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]

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 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]

Citations

1. Denmark pubmed.ncbi.nlm.nih.gov

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. [2022]

2. United States 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. [2019]

3. Turkey pubmed.ncbi.nlm.nih.gov

Effects of Mental Imagery on Muscular Strength in Healthy and Patient Participants: A Systematic Review. [2019]

4. Germany pubmed.ncbi.nlm.nih.gov

Increased muscle activation following motor imagery during the rehabilitation of the anterior cruciate ligament. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Magnetic resonance imaging of reconstructed anterior cruciate ligament. [2022]

7. England 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. [2021]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of personality traits on rehabilitation effect after anterior cruciate ligament reconstruction: An observational study. [2022]