Effectiveness of motor imagery in postoperative outcomes after anterior cruciate ligament reconstruction

Abstract

BACKGROUND

Motor imagery (MI) is a cognitive intervention that enhances post-operative recovery, particularly following anterior cruciate ligament reconstruction (ACLR).

AIM

To determine the effectiveness of MI-based psychological interventions on postoperative pain, psychological outcomes, functional recovery, and return to sport following ACLR.

METHODS

This systematic review evaluated the impact of MI on critical outcomes, including pain, knee function, kinesiophobia, and return-to-sport readiness in ACLR patients. A systematic search was performed in four electronic databases (PubMed, EMBASE, Scopus, Web of Science) to identify relevant studies that provided data on the effects of administering imagery techniques on the postoperative outcomes following ACLR. Eligible studies’ characteristics, patient demographics, and leading study outcomes were extracted.

RESULTS

Twelve studies including 526 individuals (266 in intervention groups, 118 in placebo groups, and 142 in control groups) were included in the qualitative synthesis. MI was most commonly administered three times per week following ACLR, with intervention durations ranging from 6 days to 24 weeks; a 24-week period was the most frequently reported. Several studies reported improvements in kinesiophobia and psychological readiness to return to sport in patients receiving imagery-based interventions compared with placebo or usual care; however, these effects were not consistent across all trials and should be interpreted with caution.

CONCLUSION

Given the psychological burden associated with ACLR, MI represents a promising adjunct to standard rehabilitation that warrants more rigorous evaluation.

Keywords: Anterior cruciate ligament; Motor imagery; Anterior cruciate ligament reconstruction; Postoperative rehabilitation; Psychological interventions; Return to sport

Core Tip: This article examined the impact of motor imagery (MI), a cognitive strategy involving the mental rehearsal of movement, on recovery following anterior cruciate ligament reconstruction. Across 12 randomized controlled trials (526 patients), MI was associated with reductions in postoperative pain and kinesiophobia (fear of reinjury) and with improved psychological readiness to return to sport in several studies, although findings were not consistently statistically significant. Integrating MI into conventional rehabilitation may offer additional psychological benefits and, in some cases, functional improvements after anterior cruciate ligament reconstruction. Larger, high-quality trials with standardized MI protocols are needed to clarify its clinical efficacy and optimal application in postoperative care.