Effect of Virtual Reality and Augmented Reality Training for Injury Prevention and Accelerating Rehabilitation of Anterior Cruciate Ligament Injury in Athletes: A Scoping Review

Abstract

Context: Recently, the use of Virtual reality (VR) and Augmented reality (AR) tools for assessing athletes’ performance in returning to sports and neuromuscular training has experienced significant growth across all age groups. Through this technology, by utilizing laboratory facilities and creating a three-dimensional simulated sports environment that closely resembles the reality and conditions of each sports discipline, athletes can train and undergo evaluation under controlled conditions. The VR and AR systems have been used recently to prevent and rehabilitate Anterior Cruciate Ligament (ACL) injuries and assess the motor control of injured individuals. This scoping review aimed to investigate the impact of VR and AR exercises on ACL injury prevention, ACL rehabilitation, and expediting the return to sports process. Evidence Acquisition: The scoping review follows the reporting system of systematic and meta-analysis studies (PRISMA-ScR) and utilizes the guidelines provided by the Joanna Briggs Institute for conducting various stages of work and data extraction. This study was registered in the PROSPERO database with code CRD42023446354. The search for English articles was conducted in electronic databases, including PubMed, Embase, Web of Science, SPORT Discuss, PsycINFO, CINAHL, and Cochrane, using keywords such as virtual reality, rehabilitation, injury prevention, simulation, augmented reality, ACL, and anterior cruciate ligament until the end of June 2022. Inclusion criteria encompassed any primary research involving both athletes and non-athletes across all levels (from beginners to professional) and all ages and genders (male and female) who have experienced unilateral anterior cruciate ligament injury and have undergone any type and degree of sports or therapeutic intervention using VR and AR systems. Results: Twenty-six out of 204 comprehensive studies were reviewed based on the inclusion and exclusion criteria. The results showed that biomechanical parameters related to ACL injury were measured using various methods such as real-time biofeedback, virtual reality, and augmented reality. The factors investigated showed significant changes after exercise in VR and AR environments. Conclusions: Anterior cruciate ligament injury (or any other sports injury) cannot be summarized in a single musculoskeletal dimension involving mechanical or movement dysfunction. The failure of current approaches to prevent ACL injuries, rehabilitation, and risk assessment is due to the neglect of cognitive and neurological aspects of the injury. New methods such as augmented neuromuscular training (aNMT), multidimensional rehabilitation approaches, and the utilization of virtual reality technology and novel training strategies based on the strengths of VR and AR systems (such as optimal strategy) can compensate for this scientific and practical gap.