Effect of Intraoperative Live Video Viewing on Kinesiophobia After ACL Reconstruction (VIDEO-ACLR)

Impact of Intraoperative Live Arthroscopic Video Viewing on Kinesiophobia and Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

The purpose of this randomized controlled trial is to investigate whether intraoperative live arthroscopic video viewing improves postoperative psychological and functional outcomes in patients undergoing primary anterior cruciate ligament (ACL) reconstruction under spinal anesthesia Participants are randomly assigned to either a video-viewing group, where they watch their surgery in real-time, or a control group receiving standard care without visual feedback The primary objective is to determine whether this patient-specific visual biofeedback reduces postoperative kinesiophobia at 24 weeks.

Secondary objectives aim to evaluate the intervention's effects on state anxiety, illness perception, postoperative pain, and patient-reported functional recovery, including IKDC, Lysholm, and SF-36 scores

.

Study Overview

• Status: Completed
• Conditions: Anterior Cruciate Ligament Injuries; Anxiety; Anterior Cruciate Ligament Reconstruction; Kinesiophobia
• Intervention / Treatment: Behavioral: Intraoperative Live Video Viewing; Procedure: Standard ACL Reconstruction

Detailed Description

Return to preinjury competitive sports following anterior cruciate ligament reconstruction (ACLR) remains suboptimal despite successful surgical and mechanical restoration Psychological factors, particularly kinesiophobia (fear of movement) and state anxiety, act as significant barriers to functional recovery, rehabilitation adherence, and return to sport Although the biopsychosocial model is increasingly recognized in orthopedic rehabilitation, patient-specific perioperative interventions designed to mitigate these psychological barriers remain limited This prospective, parallel-group, assessor-blinded, randomized controlled trial aims to investigate whether active patient engagement through intraoperative live arthroscopic video viewing can improve postoperative psychological and functional outcomes Eligible adult patients scheduled for primary ACLR under spinal anesthesia are randomized in a 1:1 ratio into an intervention (video-viewing) group or a control group All surgical procedures are performed by a single experienced orthopedic surgeon using an anatomic single-bundle reconstruction technique with a hamstring tendon autograft In the intervention group, the arthroscopic monitor is positioned within the patient's direct visual field.

While under spinal anesthesia, patients watch the procedure live During the operation, the surgeon provides a standardized, step-by-step verbal explanation of the normal intra-articular structures, the torn ACL, the reconstruction steps, and the final graft appearance In the control group, patients receive standard surgical care and routine perioperative communication under the same anesthetic conditions but are not allowed to view the arthroscopic monitor.

To ensure the intervention is adequately delivered, patients must remain conscious and cooperative throughout the surgery; those developing deep sedation (Ramsay Sedation Scale score >2) or requiring conversion to general anesthesia are excluded Following surgery, both groups undergo an identical, standardized rehabilitation protocol This protocol includes early mobilization with an angle-adjustable brace, immediate weight-bearing as tolerated, deep vein thrombosis prophylaxis, and a progressive home exercise program focusing on quadriceps strengthening Data collection is performed preoperatively and at 4 and 24 weeks postoperatively by independent clinical specialists who are completely blinded to group allocation An independent psychiatrist evaluates psychological outcomes, including the Tampa Scale of Kinesiophobia (TSK-11, primary outcome), the State-Trait Anxiety Inventory (STAI), and the Brief Illness Perception Questionnaire (B-IPQ) Concurrently, an independent Physical Medicine and Rehabilitation specialist assesses functional outcomes and pain using the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Lysholm Knee Score, the Short Form-36 (SF-36) Physical Function subscale, and a Visual Analog Scale (VAS) for pain The primary objective is to determine if real-time visualization of the reconstructed knee anatomy reduces postoperative kinesiophobia at 24 weeks compared to standard care

• Study Type: Interventional
• Enrollment (Actual): 65
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Konya, Turkey (Türkiye), 42020
    • Konya City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 18 years and older.
• Diagnosis of isolated anterior cruciate ligament (ACL) rupture.
• Scheduled to undergo primary arthroscopic ACL reconstruction under spinal anesthesia.

Exclusion Criteria:

• Concomitant knee injuries requiring additional surgical procedures that substantially alter early postoperative weight-bearing and rehabilitation (e.g., meniscal repair or microfracture)
• Multiligament injury or posterior cruciate ligament (PCL) injury.
• Advanced chondral damage, rheumatologic disease, bleeding diathesis, or active local/systemic infection
• Psychiatric disorders requiring active treatment
• Inability to remain conscious, cooperative, and communicative throughout the procedure (e.g., developing deep sedation with a Ramsay score >2 or requiring conversion to general anesthesia)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Video Viewing Group; Participants view the arthroscopic procedure live on the operating room monitor while under spinal anesthesia; The monitor is positioned within the patient's direct visual field; During the procedure, the operating surgeon provides standardized step-by-step verbal explanations describing the normal intra-articular structures, the torn ACL, the major steps of reconstruction, and the final appearance of the graft; All other perioperative management, standard surgical care, and postoperative rehabilitation are identical to the control group	Behavioral: Intraoperative Live Video Viewing; A patient-centered cognitive intervention providing real-time visual feedback of the reconstructed knee anatomy to mitigate psychological barriers such as kinesiophobia and; Other Names: Visual Biofeedback
Active Comparator: Control Group; Participants undergo the same standardized arthroscopic anterior cruciate ligament reconstruction procedure under the same anesthetic and perioperative conditions as the experimental group, but are not allowed to view the arthroscopic monitor . They receive routine perioperative communication and standard surgical care, but no structured intraoperative explanation of arthroscopic findings or reconstruction steps is provided	Procedure: Standard ACL Reconstruction; Routine primary arthroscopic anterior cruciate ligament reconstruction without targeted visual or structured cognitive interventions.; Other Names: Standard Surgical Care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tampa Scale of Kinesiophobia (TSK-11) Score	Kinesiophobia (fear of movement or reinjury) is assessed using the 11-item Tampa Scale of Kinesiophobia. The total score ranges from 11 to 44, with higher scores indicating a greater degree of kinesiophobia and fear of movement.	Preoperative (baseline), 4 weeks postoperatively, and 24 weeks postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State-Trait Anxiety Inventory (STAI) Score	Postoperative state anxiety is measured using the STAI. Higher scores indicate greater levels of anxiety.	Preoperative (baseline), 4 weeks postoperatively, and 24 weeks postoperatively
Brief Illness Perception Questionnaire (B-IPQ) Score	The B-IPQ is used to assess the cognitive and emotional representations of the patient's illness/injury. Higher scores indicate more threatening views and a more negative perception of the illness.	Preoperative (baseline), 4 weeks postoperatively, and 24 weeks postoperatively
Visual Analog Scale (VAS) for Pain	Postoperative pain intensity is assessed using a Visual Analog Scale. Scores range from 0 to 10, with 0 representing "no pain" and 10 representing "worst possible pain." Higher scores indicate greater pain severity.	4 weeks and 24 weeks postoperatively
International Knee Documentation Committee (IKDC) Subjective Knee Form Score	The IKDC Subjective Knee Form is used to evaluate patient-reported knee symptoms, function, and sports activity. Scores are transformed to a scale of 0 to 100, with higher scores indicating fewer symptoms, better knee function, and higher levels of sports activity.	4 weeks and 24 weeks postoperatively
Lysholm Knee Score	The Lysholm Knee Score is a condition-specific outcome measure that evaluates knee function and symptoms, such as limping, locking, pain, and instability. The total score ranges from 0 to 100, with higher scores representing better knee function and fewer symptoms.	4 weeks and 24 weeks postoperatively
Short Form-36 (SF-36) Physical Function Subscale Score	Patient-reported physical functioning is evaluated using the Physical Function subscale of the SF-36 health survey. Scores are transformed to range from 0 to 100, with higher scores indicating better physical functioning and less limitation.	4 weeks and 24 weeks postoperatively

Collaborators and Investigators

• Sponsor: Konya City Hospital
• Investigators: Principal Investigator: Oğuzhan Pekince, MD, Konya City Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): April 20, 2025
• Study Completion (Actual): April 10, 2026

Study Registration Dates

• First Submitted: April 14, 2026
• First Submitted That Met QC Criteria: April 14, 2026
• First Posted (Actual): April 20, 2026

Study Record Updates

• Last Update Posted (Actual): April 20, 2026
• Last Update Submitted That Met QC Criteria: April 14, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Anterior Cruciate Ligament Reconstruction; Anxiety; Kinesiophobia; Functional Recovery; Visual Biofeedback; Intraoperative Video
• Additional Relevant MeSH Terms: Mental Disorders; Wounds and Injuries; Leg Injuries; Knee Injuries; Phobic Disorders; Anterior Cruciate Ligament Injuries; Kinesiophobia; Anxiety Disorders
• Other Study ID Numbers: NEU-ORTHO-ACL-2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared publicly in order to protect patient privacy and confidentiality. However, aggregate data will be available through publication.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No