All studies data.

ObjectiveThe objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR).MethodsThis meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model.ResultsSix RCTs with a total of 464 patients after unilateral ACLR were included for 8–12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39).ConclusionSince many of the included results are based on low—or very—low—quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower—limb balance training, the application of VR might be advantageous for the recovery of patients’ knee joint function, lower—limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

目的 本项系统综述与meta分析旨在明确前交叉韧带重建术（Anterior Cruciate Ligament Reconstruction, ACLR）后虚拟现实（Virtual Reality, VR）平衡训练的康复疗效。
方法 本项meta分析已在PROSPERO平台注册，注册号为CRD42024520383。研究系统检索了PubMed、Web of Science、Cochrane图书馆、MEDLINE、Embase、中国知网（China National Knowledge Infrastructure, CNKI）、中国生物医学文献数据库、中国科技期刊数据库以及万方数字化期刊数据库，检索时限为建库至2024年1月，以筛选符合纳入标准的相关研究。本次分析的结局指标包括国际膝关节文献委员会评分（International Knee Documentation Committee, IKDC）、视觉模拟评分法（Visual Analogue Scale, VAS）、Holden分级、伸肌峰力矩（Extensor Peak Torque, EPT）、屈肌峰力矩（Flexor Peak Torque, FPT）、膝关节反应时以及膝关节复制角度差。采用随机效应模型计算合并均数差（Mean Difference, MD）及95%置信区间（Confidence Interval, CI）。
结果 最终纳入6项随机对照试验，共包含464例单侧前交叉韧带重建术后患者，受试者接受8~12周的虚拟现实平衡训练干预。结果分析显示，与常规康复对照组相比，虚拟现实平衡训练组的前交叉韧带重建术后患者在国际膝关节文献委员会评分（MD=3.88, 95%CI: 0.95~6.81）、Holden分级（MD=0.42, 95%CI: 0.33~0.51）、伸肌峰力矩（MD=12.03, 95%CI: 3.28~20.78）及屈肌峰力矩（MD=14.57, 95%CI: 9.52~19.63）方面均获得显著改善；同时该组患者的膝关节反应时（MD=-0.30, 95%CI: -0.35~-0.25）、30°位膝关节复制角度差（MD=-0.88, 95%CI: -1.16~-0.61）、60°位膝关节复制角度差（MD=-0.80, 95%CI: -1.09~-0.50）及视觉模拟评分（MD=-0.52, 95%CI: -0.65~-0.39）均显著降低。
结论 由于纳入研究的多数证据质量为低或极低，尽管本研究结果呈现出一定的趋势，但结论仍存在较大不确定性。在前交叉韧带重建术后康复训练及下肢平衡训练中，虚拟现实技术或可助力患者膝关节功能、下肢肌肉力量、本体感觉恢复以及疼痛管理，而沉浸程度可能会对康复结局产生影响。受限于数据质量、异质性以及样本量较小等问题，本研究结论的论证强度有所削弱。上述发现仍需后续开展大规模前瞻性研究予以验证。