Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 21, 2026
Date Accepted: Apr 20, 2026
Virtual Reality Mindfulness Meditation for Patients after ACL Reconstruction: An NIH Stage 1 Behavioral Intervention Development Protocol
ABSTRACT
Background:
About 1 in 3 individuals will sustain a secondary anterior cruciate ligament (ACL) injury within 24 months of return to sport after ACL reconstruction (ACLR). While aberrant biomechanics and poor quadriceps strength have been associated with secondary ACL injury risk, unresolved injury-related fear has also been identified as a potential risk factor for additional ACL injuries in previously high functioning, physically active populations. Virtual reality mindfulness meditation (VRMM) is a psychological skill that may reduce injury-related fear and improve an individuals’ ability to stay in the present moment during stressful situations such as sport. There is a critical need to identify whether VRMM is a feasible intervention that could be implemented to address injury-related fear and reduce secondary ACL injury risk.
Objective:
Determine the feasibility, acceptability, and preliminary efficacy of a VRMM intervention with neuromuscular training rehabilitation (NTR) to reduce injury-related fear and improve jump landing biomechanics in females with history of ACLR, when compared to a sham VR intervention + NTR.
Methods:
A double-blinded two arm feasibility trial of 48 participants (24 per group) comparing VRMM+NTR to VR sham+NTR will be conducted. Recruitment, retention, adherence, and acceptability outcomes will be collected throughout the trial. Injury-related fear will be measured using the 11 item Tampa Scale of Kinesiophobia (TSK-11). Jump-landing biomechanics will be assessed via peak knee abduction moment and peak knee flexion excursion. Change in outcomes will be compared between groups using 2x2 repeated measures ANOVA and partial η2 effect sizes. Significance will be set at p < 0.05.
Results:
The trial started in September 2023 and is anticipated to finish in May 2027. We expect to observe acceptable rates of retention, adherence, and acceptability to the VRMM intervention and more favorable outcomes in the VRMM+NTR group compared the VR sham+NTR group.
Conclusions:
The results of this trial will improve our understanding of the feasibility of VRMM and inform next steps in behavioral intervention development to test the efficacy of VRMM to reduce injury-related fear in females after ACLR. Clinical Trial: ClinicalTrials.gov: NCT05527171, https://clinicaltrials.gov/study/NCT05527171?intr=Virtual%20Reality%20Mindfulness%20Meditation&rank=2
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