Extended Reality & Virtual Reality for Return-to-Sports Screening

Anterior cruciate ligament (ACL) injuries are common in sports such as soccer, often requiring extensive rehabilitation post-surgery. Return-to-sport (RTS) rehabilitation protocols typically involve clinical and kinematic evaluations to ensure safety. This study investigates the added value of non-immersive (Extended Reality XR) and immersive (Virtual Reality VR) on movement quality during RTS assessment of male soccer players post ACL reconstruction, compared to healthy control players. Our XR tests were performed using a projection on a big screen on 11 male soccer players with a soccer-related ACL tear. Additionally, our VR tests were performed using a Head Mounted Display (HMD) on 31 male soccer players, including 14 with ACL reconstruction and 17 healthy control players. We performed clinical tests and kinematic analyses with statistical comparisons between testing conditions. The utilization of XR seems to elicit the mechanism associated with ACL rupture more significantly, suggesting its potential value in incorporating XR into RTS screening and rehabilitation protocols. Analysis of the VR-results revealed greater knee flexion and valgus range compared to non-VR, demonstrating VR's potential for enhanced kinematic sensitivity. As such, VR-based kinematic analysis may improve sensitivity in detecting movement deviations during RTS evaluations post-ACLR. Further research is needed across diverse athletic populations. In conclusion, this study highlights the potential for both XR and VR applications in identifying ACLR-related deficits, and motivates their integration with conventional clinical RTS screening batteries.