KSSTA - 2026-03-18 - Journal Article
A rehabilitation programme performed in darkness after anterior cruciate ligament reconstruction reduces the risk of secondary injuries.
Wein F, Leclerc E, Richard J, Goetzmann T, Walbron P
Topics
Key Takeaway
Dark-environment rehabilitation after ACL reconstruction reduced contralateral ACL rupture rate from 13.1% to 5.7% (p=0.01) at mean 5.8-year follow-up, with no significant difference in ipsilateral graft re-rupture (7.1% vs. 3.2%, p=0.18).
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Summary
This retrospective single-centre cohort compared conventional lit rehabilitation to a programme alternating lit and dark (<10 lux) conditions beginning at 4 months post ACL reconstruction with concomitant anterolateral ligament reconstruction. Contralateral ACL rupture was significantly lower in the Darkness group (5.7% vs. 13.1%, p=0.01), while ipsilateral re-rupture trended lower but did not reach significance (3.2% vs. 7.1%, p=0.18). Return-to-sport level was higher in the Darkness group (Tegner 6.0 vs. 5.3, p=0.04), but IKDC, KOOS, Lysholm, and ACL-RSI scores did not differ between groups.
Key Limitation
Self-selection of rehabilitation group is the critical flaw; unmeasured confounders including compliance, training volume, coach quality, and psychological readiness cannot be excluded as drivers of the contralateral injury difference.
Original Abstract
PURPOSE
To evaluate whether integrating partial visual deprivation during the reathletization phase after anterior cruciate ligament (ACL) reconstruction improves proprioceptive recovery and reduces the risk of graft failure or contralateral injuries.
METHODS
We conducted a retrospective, single-centre cohort study including patients aged older than 16 years who underwent ACL reconstruction with autograft and concomitant anterolateral ligament reconstruction between November 2017 and March 2020. Patients voluntarily chose between two reathletization programmes starting from the fourth postoperative month: Group 1 (Conventional): exercises performed exclusively in a well-lit environment (n = 372). Group 2 (Darkness): exercises alternating between well-lit and controlled dark conditions (<10 lux) (n = 131). Primary outcome was ACL graft re-rupture; secondary outcomes included contralateral ACL rupture, functional scores (International Knee Documentation Committee [IKDC] Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm, ACL-Return to Sport after Injury [ACL-RSI]) and return-to-sport level (Tegner Activity Scale). A minimum follow-up of 5 years was required. Groups were matched for age, sex, graft type, baseline sports level and associated meniscal lesions.
RESULTS
A total of 446 patients (mean follow-up: 5.8 ± 0.7 years) were analysed. The overall re-rupture rate was 5.4% and tended to be lower in the Darkness group (3.2%) compared to the Conventional group (7.1%; p = 0.18). Contralateral ACL ruptures were significantly less frequent in the Darkness group (5.7% vs. 13.1%; p = 0.01). Functional scores (IKDC, KOOS, Lysholm, ACL-RSI) showed no significant differences between groups. However, the final return-to-sport level was significantly higher in the Darkness group (Tegner 6.0 vs. 5.3; p = 0.04).
CONCLUSION
A reathletization programme incorporating partial visual deprivation after ACL reconstruction may reduce the risk of contralateral injuries, despite no significant difference in functional scores. This simple, feasible approach warrants further evaluation in prospective controlled studies.
LEVEL OF EVIDENCE
Level III.