Sports Medicine ( IF 9.3 ) Pub Date : 2024-08-17 , DOI: 10.1007/s40279-024-02085-2 Emanuele Tortoli 1, 2 , Alli Gokeler 3 , Igor Tak 4, 5 , Leonardo Pellicciari 6 , Grant Norte 7
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Background
Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.
Objectives
The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.
Design
Scoping review.
Literature search
We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.
Study selection criteria
Only primary studies published in English were included without time limitations.
Data synthesis
Qualitative analysis of the included studies was performed.
Results
We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.
Conclusions
Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.
Level of evidence
IV.
The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).
中文翻译：
前交叉韧带受伤后运动员的视觉依赖度是否增加？范围界定审查
背景
前交叉韧带 （ACL） 损伤的个体在需要神经肌肉控制的任务中经常表现出视觉认知缺陷。在本文中，我们提供了在一系列临床适用的认知运动任务中 ACL 损伤后视觉依赖性增加的证据。这些信息对于加强针对适应不良神经可塑性的治疗干预的科学依据至关重要，并可能转化为改善 ACL 损伤后重返运动 （RTS） 的结果。
目标
本研究的目标是 （1） 确定在 ACL 缺陷 （ACL-D） 或 ACL 重建 （ACL-R） 后的常见基于康复的评估中是否存在视觉依赖，（2） 描述在此类任务中如何评估视觉依赖，以及 （3） 提供信息以帮助临床医生和患者了解认知负荷在视觉依赖评估和干预中的临床相关性。
设计
范围界定审查。
文献检索
我们检索了MEDLINE、EMBASE、CINAHL、SCOPUS和PEDro数据库。
研究选择标准
仅纳入以英文发表的原始研究，没有时间限制。
数据合成
对纳入的研究进行定性分析。
结果
我们综合了 23 项研究的结果。共有 7 项研究 （31%） 纳入了 ACL-D 患者，15 项研究 （65%） 纳入了 ACL-R 患者，1 项研究 （4%） 纳入了 ACL-D 和 ACL-R 患者。确定了任务评估、任务评估设置、视觉条件、结果测量和视觉依赖增加的存在。与 ACL-R 患者相反，大多数调查 ACL-D 患者的研究在闭眼条件下的姿势稳定性比未受伤的对照组差。完全视觉阻塞 （即闭上眼睛或蒙住眼睛） 是最常报告的破坏视力的方法 （52%）。与对照组相比，增加视觉认知挑战导致 ACL-R 患者的姿势稳定性显著变差。
结论
在完全视觉阻塞的单腿站姿期间，最常评估视觉依赖性。对 ACL-D 患者的大多数研究表明，与未受伤的对照组相比，他们在闭眼条件下表现出较差的姿势稳定性，这表明视觉依赖性增加。与 ACL-D 患者相比，接受 ACL-R 的患者视觉依赖性的证据较少。发现增加视觉认知负荷在诱导接受 ACL-R 的个体的姿势稳定性缺陷方面更有效。
证据级别
四。
该协议是在开放科学框架 （https://osf.io/p4j95/） 上注册的。
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