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：
ACL 损伤后运动员的视觉依赖是否会增加？范围界定审查
背景
患有前十字韧带 (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，我们提出了 ACL 损伤后在一系列临床适用的认知运动任务中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措施的科学依据至关重要，并可能转化为改善 ACL 损伤后恢复运动 (RTS) 的结果。
目标
本研究的目的是 (1) 确定在 ACL 缺陷 (ACL-D) 或 ACL 重建 (ACL-R) 后的常见康复评估中是否存在视觉依赖，(2) 描述在 ACL 缺陷 (ACL-D) 或 ACL 重建 (ACL-R) 后如何评估视觉依赖此类任务，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初步研究，没有时间限制。
数据综合
对纳入的研究进行了定性分析。
结果
我们综合了 23 项研究的结果。共有 7 项研究 (31%) 纳入 ACL-D 患者，15 项研究 (65%) 纳入 ACL-R 患者，1 项研究 (4%) 纳入 ACL-D 和 ACL-R 患者。确定了任务评估、任务评估设置、视觉条件、结果测量以及视觉依赖增加的存在。大多数研究 ACL-D 患者的研究与 ACL-R 患者相反，在闭眼条件下表现出比未受伤的对照组更差的姿势稳定性。完全视觉障碍（即闭眼或蒙住眼睛）是最常报告的视力障碍方法（52%）。与对照组相比，增加视觉认知挑战导致 ACL-R 患者的姿势稳定性明显较差。
结论
视觉依赖最常在视觉完全受阻的单腿站立期间进行评估。大多数针对 ACL-D 患者的研究表明，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 患者视觉依赖的证据较少。研究发现，增加视觉认知负荷对于诱发 ACL-R 患者的姿势稳定性缺陷更为有效。
证据级别
四．
该协议已预先在开放科学框架（https://osf.io/p4j95/）上注册。
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