588 BO23 – Virtual reality in return to sport screening after ACL reconstruction- just for fun or a serious game?

Background Recent research showed that currently accepted RTS criteria do not sufficiently identify patients at risk for an ACL reinjury. Interestingly, many of the sports where the ACL (re)injury is high, are characterized by sudden, sometimes unforeseen, changes in direction and constant attention to the environment is paramount. With the help of Virtual Reality (VR), sport-specific life-like situations can be created, shifting the athlete's focus to the VR game instead of the injured knee. Therefore, VR guided RTS screening could be more suited to detect residual functional kinematic deficits after ACLR. Objective To investigate the effect of VR on movement quality during RTS evaluation in male football players after ACLR compared to the healthy matched controls. Design A kinematic case-control study. Setting All participants performed a kinematic RTS testing in which cutting and header maneuvers were evaluated in both VR and non-VR guided settings. Patients Forty male football players were included (20 ACLR patients, 20 healthy matched controls). Assessment of risk factors The kinematic testing was conducted in a VR situation, where the participants wore a head mounted display and a non-VR situation, where Reaction Lights were used. Main outcome measurements Knee angles were calculated, with particular focus on the ground-contact phases during the cutting and landing tasks. Results The VR condition showed more flexion (average p = 0.044) and adduction (average p = 0.029; maximal p = 0.012) during the push-off phase of the side cutting maneuver. Also, only the VR condition was able to identify bilateral differences, sparing the affected leg during landing (p = 0.016). Conclusion The biomechanical risk profile for (re)injury was more provoked during VR screening, probably due to the external focus of attention through immersion. So, although still in its infancy, VR seems to be promising to incorporate for screening purposes.