Fractal versus steady visual walking cues after ACL reconstruction

Comparison Between a Session of Walking Synchronized to Fractal- VS Isochronous-Based Cues on Gait Variability and Corticospinal Measures in Athletes With a Reconstructed Anterior Cruciate Ligament: A Crossover Randomized Controlled Trial

This tests whether fractal (variable) visual walking cues or steady metronome-like cues help athletes who had ACL reconstruction walk with steadier, safer patterns.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 36 (estimated)
• Ages: 15 Years to 35 Years
• Sex: All
• Sponsor: Egas Moniz - Cooperativa de Ensino Superior, CRL (other)
• Locations: 1 site (Almada, Monte de Caparica)
• Trial ID: NCT07243535 on ClinicalTrials.gov

What this trial studies

This randomized crossover trial has each participant complete two treadmill walking sessions with visual cues: one using individualized fractal cueing and one using isochronous (steady) cueing, with the order randomized. Each cued trial lasts 12 minutes and is surrounded by uncued walking trials, while gait is recorded at high resolution by a Bertec treadmill. Fractal cues are personalized to each person’s stride-time variability using a fractal algorithm and detrended fluctuation analysis, whereas isochronous cues match average stride time without variability. Participants synchronize heel strikes of the reconstructed limb to a moving bar on a screen while supervised by trained staff.

Who should consider this trial

Good fit: Ideal candidates are athletes who had unilateral ACL reconstruction within the past two years, are cleared for full loading, can walk pain-free, and can understand and perform the synchronization task.

Not a fit: Patients with prior knee surgeries, recent other lower-limb injuries, major systemic or neurological conditions, or who cannot perform the task are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, this approach could reduce gait variability and lower the risk of re-injury and long-term joint degeneration after ACL reconstruction.

How similar studies have performed: Previous work on sensorimotor synchronization and gait cueing has shown promise for modifying gait variability and promoting neuroplasticity, but applying individualized fractal cueing specifically to post-ACL athletes is relatively novel with limited direct evidence.

Eligibility criteria

Inclusion Criteria:

* Undergone unilateral ACL reconstruction less than 2 years ago;
* Have medical release for the full load on the injury limb for at least 2 weeks;
* Be independently pain-free walking;
* Being sports athletes according to an athlete description: Training regularly to improve performance, actively participating in competitions or formally registering in a sports federation or association;
* Must be able to understand and perform the requested task.

Exclusion Criteria:

* Participants with previous surgery on either knee;
* Those with more than 3 months between ACL injury and surgery;
* More than 2 weeks between surgery and the start of physical therapy;
* Had another musculoskeletal injury in the lower limb within the past 6 months;
* Another musculoskeletal surgery within the past 18 months;
* Participants with a history of movement system pathologies, such as nervous system, cardiovascular, pulmonary, integumentary, or endocrine conditions;
* Participants with vestibular or somatosensory system pathologies or visual impairments limiting their ability to see the metronome required for the task;
* Use of medications that could affect locomotion and balance.

Where this trial is running

Almada, Monte de Caparica

• Egas Moniz School of Health & Science — Almada, Monte de Caparica, Portugal (RECRUITING)

Study contacts

• Study coordinator: Inês D Ribeiro, MSC Student

Conditions: Anterior Cruciate Ligament Reconstruction, Anterior Cruciate Ligament Reconstruction Rehabilitation, Athlete, Complexity, Excitability, Metronome, Neuroplasticity, Rehabilitation