Du Chao, Gu Nei-Meng, Guo Tian-Ci, Liu Ai-Feng
Orthopedics Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Traditional Chinese Medicine and Acupuncture, Tianjin, China.
PLoS One. 2025 Jan 14;20(1):e0316400. doi: 10.1371/journal.pone.0316400. eCollection 2025.
The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR).
This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model.
Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.956.81), Holden grading (MD = 0.42, 95%CI: 0.330.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.2820.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.5219.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09-0.50), and VAS score (MD = -0.52, 95%CI: -0.65-0.39).
Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.
本系统评价和荟萃分析的目的是阐明前交叉韧带重建（ACLR）后虚拟现实（VR）平衡训练的康复效果。
本荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024520383。系统检索电子数据库PubMed、科学引文索引（Web of Science）、考克兰图书馆、医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（Embase）、中国知网、中国生物医学文献数据库、中国科技期刊数据库和万方数据期刊数据库，以识别从创刊至2024年1月的符合条件的研究。研究的结局指标包括国际膝关节文献委员会（IKDC）评分、视觉模拟评分法（VAS）、霍尔登分级、伸肌峰值扭矩（EPT）、屈肌峰值扭矩（FPT）、膝关节反应时间、膝关节角度重现差异。采用随机效应模型计算合并平均差（MD）和95%置信区间（CI）。
纳入6项随机对照试验，共464例单侧ACLR术后患者，进行为期8至12周的VR平衡训练干预。结果分析表明，与传统康复对照组相比，VR平衡训练组显著提高了ACLR术后患者的国际膝关节文献委员会（IKDC）评分（MD = 3.88，95%CI：0.956.81）、霍尔登分级（MD = 0.42，95%CI：0.330.51）、伸肌峰值扭矩（EPT）（MD = 12.03，95%CI：3.2820.78）和屈肌峰值扭矩（FPT）（MD = 14.57，95%CI：9.5219.63），并显著缩短了膝关节反应时间（MD = -0.30，95%CI：-0.35-0.25）、30°时膝关节角度重现差异（MD = -0.88，95%CI：-1.16-0.61）、60°时膝关节角度重现差异（MD = -0.80，95%CI：-1.09-0.50）以及VAS评分（MD = -0.52，95%CI：-0.65-0.39）。
由于纳入的许多结果基于低质量或极低质量的证据，尽管结果显示出一定趋势，但结论具有很大的不确定性。在ACLR后的康复训练和下肢平衡训练中，VR的应用可能有利于患者膝关节功能、下肢肌肉力量、本体感觉和疼痛管理的恢复。沉浸程度可能会影响康复效果。由于数据质量和异质性的局限性以及样本量较小，结论的力度有所减弱。这些发现应在进一步的大规模前瞻性研究中得到验证。
