Virtual Reality Mindfulness Meditation in Patients after Anterior Cruciate Ligament Reconstruction

Injury-related fear after anterior cruciate ligament (ACL) injury significantly contributes to decreased
return to sport, decreased physical activity engagement, and increased ACL reinjury risk in previously high
functioning, physically active individuals. Injury-related fear is also associated with poor jump-landing
movement patterns in patients after ACL reconstruction (ACLR). Unfortunately, current rehabilitation practices
do not specifically address injury-related fear in patients after ACLR. Virtual reality mindfulness meditation is a
mental practice that involves focusing your mind on your experiences in the present moment and has been
used to address depression, anxiety, and chronic musculoskeletal pain. Additionally, mindfulness meditation
has led to positive changes in brain activity in individuals with depression, anxiety, and chronic musculoskeletal
pain. Patients after ACLR exhibit poor brain activity similar to individuals with depression, anxiety, and chronic
musculoskeletal pain; thus, patients after ACLR may also benefit from mindfulness meditation. To evaluate the
effect of virtual reality mindfulness meditation on patients after ACLR, we will determine the effect of virtual
reality mindfulness meditation to 1) decrease self-reported injury-related fear, 2) improve poor jump-landing
movement patterns, and 3) improve brain activity in women 9-months post-ACLR when compared to a virtual
reality sham group. Injury-related fear and poor jump-landing movement patterns have been associated with
ACL reinjury risk. Women were selected for this study as previous literature has demonstrated sex differences
in brain activity and women also have a higher incidence of ACL injury and ACL reinjury risk. All patients in the
study will complete an 8-week advanced rehabilitation training program to improve lower-body muscle
strength, power, and flexibility. Patients in the intervention group will complete 8-weeks of virtual reality
mindfulness meditation + the advanced rehabilitation training program. Patients in the sham group will
complete 8-weeks of the virtual reality sham + the advanced rehabilitation training program. The central
hypothesis is that women 9-months post ACLR who undergo virtual reality mindfulness meditation will
demonstrate decreased injury-related fear, improved jump-landing movement patterns, and improved brain
activity. The findings from this proposal will address a gap in knowledge about effective psychological
interventions to address psychological and biological factors associated with ACL reinjury risk. This proposal
also positions an aspiring independent clinician scientist training to learn neuroimaging techniques and
complex movement pattern data collection and analyses. With this training, the primary investigator will
examine the efficacy of virtual reality mindfulness meditation to mitigate injury-related fear, decrease ACL
reinjury risk, and improve quality of life in patients after ACLR throughout her career as a clinician scientist.

Grant Number: 5K23AR079056-05
NIH Institute/Center: NIH
Principal Investigator: Shelby Baez