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

José Manuel Pastora-Bernal,Rocío Martín-Valero,David Lucena-Anton,Antonio Bort-Carballo,María José Estebanez-Pérez,Francisco José García-López

doi:10.3390/jcm10030428

Abstract

Motor imagery (MI) reported positive effects in some musculoskeletal rehabilitation processes. The main objective of this study was to analyze the effectiveness of MI interventions after anterior cruciate ligament (ACL) reconstruction. A systematic review was conducted from November 2018 to December 2019 in PubMed, Scopus, Web of Science, The Cochrane Library, and Physiotherapy Evidence Database (PEDro). The methodological quality, degree of recommendation, and levels of evidence were analyzed. A total of six studies were included. Selected studies showed unequal results (positive and negative) regarding pain, anxiety, fear of re-injury, function, and activities of daily living. Regarding the range of motion, anthropometric measurements, and quality of life, the results were not conclusive. Muscle activation, strength, knee laxity, time to remove external support, and neurobiological factors showed some favorable results. Nevertheless, the results were based on a limited number of studies, small sample sizes, and a moderate-weak degree of recommendation. In conclusion, our review showed a broader view of the current evidence, including a qualitative assessment to implement MI after ACL surgery. There was no clear evidence that MI added to physiotherapy was an effective intervention after ACL surgery, although some studies showed positive results in clinical outcomes. More adequately-powered long-term randomized controlled trials are necessary.

Highlights

Anterior cruciate ligament (ACL) injury has a high incidence in sports and recreational activities
We aimed to identify the different modalities of intervention within motor imagery (MI) that can be used during the rehabilitation of the ACL, to identify changes in different variables with MI-based interventions, and to identify levels of evidence
The search was focused on MI and ACL, and it has been conducted in the following scientific databases: PubMed, Scopus, Web of Science (WOS), The Cochrane Library, and Physiotherapy Evidence Database (PEDro)

Summary

Introduction

Anterior cruciate ligament (ACL) injury has a high incidence in sports and recreational activities. A motor act can be represented in the working memory without the realization of the external action, and this dynamic process is known as motor imagery (MI) [3]. Mental practice and physical movements follow the same rules and restrictions, as shown by some studies [16], so much so that it positively affects the learning of skills [9] and motor performance [10]. It seems that there are differences in neuronal activation, with the MI stimulus being less localized and less intense [12]

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Conclusion