Effectiveness of virtual reality technology in rehabilitation after anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Background: Anterior cruciate ligament reconstruction (ACLR) can be fully recovered with effective rehabilitation, which also lowers the risk of developing osteoarthritis in the knee. Virtual reality technology (VRT) has been used for rehabilitation after ACLR. However, it is unclear how VRT compares to traditional therapy in terms of effectiveness. Design: A systematic review and a meta-analysis. Objectives: We hypothesised that VRT would be a more effective treatment than traditional therapy in post-ACLR rehabilitation. This study aimed to evaluate the effects of VRT on rehabilitation following ACLR, providing insights for its application in clinical settings. Materials and methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed using RevMan and Stata software according to PRISMA guidelines. We conducted a systematic search of the PubMed, Web of Science, Embase, The Cochrane Library, EBSCO, CNKI, CBM, VIP, and Wanfang databases for RCTs examining the effects of VRT in patients following ACLR. The literature search was conducted from the inception of the database to March 2024, utilizing keywords such as “anterior cruciate ligament,” “anterior cruciate ligament reconstruction,” “anterior cruciate ligament injury,” and “virtual reality.” The outcome indicators comprised knee function, walking function, gait function, and knee muscle strength. We assessed the quality of RCTs using the Cochrane Risk of Bias tool and the Jadad scale. Results: There were a total of 6 RCTs included in this study, involving 387 patients who had undergone ACLR. The experimental group comprised 194 patients, while the control group comprised 193 patients. The findings demonstrated that VRT significantly enhanced knee function, walking ability, gait function, and knee muscle strength post-ACLR. Specifically, it led to improvements in the IKDC score (MD: 4.23; 95% CI 1.76-6.71), FAC score (0.40; 0.32-0.48), Lysholm score (6.36; 3.05-9.67), step length (3.99; 2.72-5.27), step speed (0.13; 0.10-0.16), step frequency (4.85; 0.22-9.47), extensor peak torque (12.03; 3.28-20.78), and flexor peak torque (14.57; 9.52-19.63). Subgroup analysis revealed that fully immersive VR did not significantly improve knee function as compared to non-immersive VR. Conclusion: This study is the first to systematically compare VRT with traditional therapy, and we found that VRT is a more effective treatment than traditional therapy in post-ACLR rehabilitation. This provides evidence for integrating VRT into post-ACLR rehabilitation protocols. However, more high-quality studies with large samples are needed to verify the findings. Protocol registration: This study has been registered in PROSPERO (No. CRD42024534918).