Motor Imagery-Enhanced Rehabilitation Modulates Cortical Plasticity and Functional Recovery After ACL Reconstruction

Part 1 employs a cross-sectional design, comparing patients one year after anterior cruciate ligament reconstruction (ACLR) (experimental group) with healthy adults (control group). This phase aims to acquire electroencephalography (EEG) and lower limb functional data across different states to elucidate the correlation between cortical function and motor behavior.

Part 2 will conduct a 12-week randomized controlled trial (RCT). ACL rupture patients will be allocated to either a motor imagery intervention group or a conventional rehabilitation control group. We will integrate EEG and kinematic analysis to systematically evaluate the therapy's effects on knee function, neuromuscular control, and brain network connectivity. Furthermore, by combining longitudinal EEG and resting-state functional magnetic resonance imaging (rs-fMRI), we will investigate the underlying neuroplastic mechanisms driving functional remodeling within the sensorimotor networks. This research is expected to establish a novel, active intervention strategy based on the "central-driven peripheral" paradigm for ACL postoperative rehabilitation.

Part 1: Participants

Study Design:

• This study will recruit 20 patients at 12 months after ACL reconstruction and 20 healthy controls.
• Age range: 18-45 years.

Inclusion criteria

for Patient Group:

• Age: 18-45 years old.
• Body Mass Index (BMI): ≥18.5 kg/m² and <35 kg/m².
• Injury Type: First-time unilateral isolated ACL rupture, reconstructed at our hospital.
• Surgical Technique: Single-bundle hamstring tendon autograft transplantation.
• Ligament Stability: No injury or only mild injury (Grade I) to the PCL, MCL, or LCL.
• Postoperative Timeline: 12 months after ACL reconstruction.
• Consent: Voluntary participation with signed informed consent.

Exclusion criteria

for Patient Group:

• Delayed Surgery: ACL reconstruction performed >6 months after injury.
• Combined Injuries: Severe injury (>Grade I) to PCL, MCL, or LCL; severe meniscus tear.
• Previous Surgery: History of lower limb knee surgery (e.g., meniscus repair, arthroplasty).
• Comorbidities: Existing knee diseases (e.g., osteoarthritis, tumors, rheumatoid arthritis, fracture).
• Systemic/Cognitive Issues: Severe cardiac, pulmonary, cerebral disease, or hepatic/renal dysfunction; visual or cognitive impairment.
• Imagery Ability: Score <55 on the KVIQ-20.

Inclusion criteria

for Healthy Controls:

• Age: 18-45 years old.
• Body Mass Index (BMI): ≥18.5 kg/m² and <35 kg/m².
• Medical History: No history of surgery, injury, or chronic lower limb joint disease.
• Neurological Status: No visual/cognitive impairment or neurological disorders.
• Gait: No trauma or disease causing gait abnormalities.
• Consent: Voluntary participation with signed informed consent.
• Imagery Ability: Score <55 on the KVIQ-20. Study 2: Participants

Study Design:

• This study aims to recruit 40 patients meeting the specified criteria.
• Randomization: Participants will be randomly allocated into an experimental group (N=20) and a control group (N=20).

Inclusion criteria

for Patients:

• Age: 18-45 years old.
• Body Mass Index (BMI): ≥18.5 kg/m² and <35 kg/m².
• Injury Type: First-time unilateral isolated ACL rupture, reconstructed at our hospital.
• Surgical Technique: Single-bundle hamstring tendon autograft transplantation.
• Ligament Stability: No injury or only mild injury (Grade I) to the PCL, MCL, or LCL.
• Consent: Voluntary participation with signed informed consent.
• Exclusion Criteria for Patients:
• Delayed Surgery: ACL reconstruction performed >6 months after injury.
• Combined Injuries: Severe injury (>Grade I) to PCL, MCL, or LCL (Grade II-III); severe meniscus tear.
• Previous Surgery: History of lower limb knee surgery (e.g., meniscus repair, ligament reconstruction, arthroplasty).
• Comorbidities: Existing knee diseases (e.g., osteoarthritis, tumors, rheumatoid arthritis, tuberculosis, infection).
• Systemic/Cognitive Issues: Severe cardiac, pulmonary, cerebral disease, or hepatic/renal dysfunction; visual or cognitive impairment.
• Imagery Ability: Score <55 on the KVIQ-20.