Virtual Reality Mindfulness Meditation in Patients after Anterior Cruciate Ligament Reconstruction

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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.