Part 1: Neural Correlates of Motor Imagery in ACLR Patients This cross-sectional study aims to systematically compare differences in electroencephalographic (EEG) activity between patients who have returned to sport one year after anterior cruciate ligament reconstruction (ACLR) and healthy controls during functional tasks and associated motor imagery. We will collect EEG activity and behavioral performance data from both groups during task execution and imagination. The primary objective is to verify whether ACLR patients exhibit a specific deficit in motor imagery capability and to characterize the abnormal functional patterns within their central sensorimotor networks. By providing an objective, neurophysiological explanation for why patients struggle to return to sport, this study seeks to establish quantifiable baseline metrics for subsequent interventional research.
Part 2: Effects and Cortical Plasticity Changes Following Motor Imagery-Enhanced Rehabilitation This randomized controlled trial (RCT) combines short-term intervention with long-term follow-up to systematically evaluate the efficacy and mechanisms of motor imagery therapy in ACLR patients. The specific objectives are threefold: First, to verify the immediate effects of the intervention on enhancing neuroplasticity and restoring motor function. Second, to assess the long-term impact on definitive clinical outcomes-specifically return-to-sport rates and time to return-through a 12-month follow-up. Third, to perform a longitudinal analysis determining whether early improvements in neurophysiological indicators can predict subsequent gains in motor performance and successful return-to-sport outcomes.
This study will recruit 20 patients at 12 months after ACL reconstruction and 20 healthy controls.
Age range: 18-45 years.
Age: 18-45 years old.
Body Mass Index (BMI): ≥18.5 kg/m² and <35 kg/m².
Delayed Surgery: ACL reconstruction performed >6 months after injury.
Combined Injuries: Severe injury (>Grade I) to PCL, MCL, or LCL; severe meniscus tear.
Previous Surgery: History of lower limb knee surgery (e.g., meniscus repair, arthroplasty).
Comorbidities: Existing knee diseases (e.g., osteoarthritis, tumors, rheumatoid arthritis, fracture).
Parallel
Motor Imagery Therapy (i.e., "mentally practicing movement")
BehavioralPart 2 will conduct a 12-week RCT. The experimental group will receive conventional rehabilitation augmented with motor imagery training. This training will be delivered via a hybrid model (in-person and online) and consist primarily of video-guided imagery sessions.
conventional rehabilitation"
BehavioralThe control group received conventional rehabilitation only. During in-person sessions, they engaged in passive observation of static photographs, without any form of active mental simulation or motor rehearsal. During remote sessions, they watched the same videos as the experimental group but proceeded directly to physical practice without prior motor imagery.
EEG delta band (0.5-4 Hz) absolute power
Raw EEG data were collected via Smarting Pro during functional assessments.
EEG theta band (4-8 Hz) absolute power
Raw EEG data were collected via Smarting Pro during functional assessments.
EEG alpha band (8-13 Hz) absolute power
Raw EEG data were collected via Smarting Pro during functional assessments.
EEG beta band (13-30 Hz) absolute power
Raw EEG data were collected via Smarting Pro during functional assessments.
Isokinetic muscle strength testing
Isokinetic peak torque of the quadriceps and hamstrings was measured to evaluate muscle strength symmetry between the injured and uninjured limbs.
Mental chronometry
Mental chronometry was assessed to compare the imagined duration of movement with the actual execution time.
Kinesthetic and Visual Imagery Questionnaire-20
The KVIQ-20 assesses subjective kinesthetic (body sensations) and visual (mental pictures) imagery abilities related to leg movements. The questionnaire consists of 20 items divided into two dimensions: Kinesthetic and Visual. Each item is rated on a 6-point Likert scale from 0 to 5 based on the clarity and richness of the imagery experienced. The total score ranges from 0 to 100. A higher score indicates greater imagery ability, meaning the patient can more vividly see the movement and feel the muscle/joint activity in their mind.
Tegner Activity Scale
used to assess patients' level of physical activity and participation in sports. This scale ranges from 0 to 10, with higher scores indicating higher activity levels. A score of 0 represents disability due to knee problems (sick leave), while a score of 10 represents participation in competitive sports such as soccer or rugby at a national elite level. The scale captures both work and recreational activities, providing a comprehensive measure of functional activity beyond simple symptom relief.
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