Sport-specific virtual reality to identify profiles of anterior cruciate ligament injury risk during unanticipated cutting

Female athletes are at an increased risk of anterior cruciate ligament (ACL) injury in competitive sport during running, jumping and cutting tasks. This risk is due to deficits in posterior chain and hip recruitment associated with aberrant frontal knee loads. The identification of these risk factors has led to targeted neuromuscular training (NMT) interventions to enhance hip neuromuscular control during such tasks. Despite the successful modification of ACL injury risk factors following NMT, the transfer of these corrected movement patterns to the sport-specific contexts has not been directly evaluated. Sport-specific virtual reality (VR) may provide the best method to measure training transfer to realistic sport performance, while still allowing appropriate experimental control and high-fidelity performance measurements. The current study examined the effect of a biofeedback-driven augmented NMT (aNMT) on skill transfer of ACL-injury resistant movement patterns during performance of sport-specific VR scenarios. Five trained athletes participated, and their performance on an unanticipated cutting task was assessed in VR prior to and after six weeks of aNMT. A significant 87% reduction in internal hip rotation was observed on the plant leg during the loading phase of cutting (p = .05), along with an observed 116% reduction during the push-off phase (p = .02), from pre- to post-training. A non-significant trend of a 19% reduction in knee abduction was also observed (p = .15). This study is the first that has utilized free ambulatory wireless VR to assess injury risk in athletes during performance of sport-specific tasks. The reduction in internal hip rotation and knee abduction align with previous findings on laboratory based tests. The current results are the first step in the validation of sport-specific VR as a tool for understanding injury risk during simulation of real-world sport performance.