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A Novel Dual-Task Paradigm for Return-to-Sport Screening After ACL Injury: A Pilot Study.

Alva Lövgren1, Andrew Strong1, Carl-Johan Boraxbekk2,3,4

  • 1Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå, Sweden, umu.se.

Translational Sports Medicine
|January 12, 2026
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Summary

Individuals with anterior cruciate ligament (ACL) reconstruction show persistent dual-task deficits, impacting cognitive and motor skills crucial for return-to-sport. This novel dual-task paradigm effectively identifies these deficits, aiding in ACL rehabilitation and assessment.

Keywords:
cognitiondual-taskkneeligamentsrehabilitationtest–retest

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Area of Science:

  • Sports Medicine
  • Neuroscience
  • Rehabilitation Science

Background:

  • Current return-to-sport screening after anterior cruciate ligament (ACL) injury is insufficient for complex cognitive-motor demands.
  • Individuals with ACL reconstruction (ACLR) may experience persistent deficits affecting sports performance.
  • Dual-tasking, which involves performing cognitive and motor tasks simultaneously, is a key component of many sports.

Purpose of the Study:

  • To evaluate dual-task ability in individuals with ACLR using a novel dual-task test paradigm.
  • To compare cognitive and motor performance between ACLR individuals and healthy controls.
  • To assess hop test performance differences between injured and non-injured legs in the ACLR group and examine test-retest reliability.

Main Methods:

  • Twenty participants (10 ACLR, 10 controls) completed a dual-task paradigm twice within a week.
  • The paradigm included a cognitive test, a drop-vertical hop test, and a hand-tapping test, all involving a visuospatial working-memory task.
  • Cognitive and motor performance, between-group/leg differences, and test-retest reliability (ICC) were analyzed.

Main Results:

  • At retest, ACLR individuals performed significantly worse than controls in most outcomes (large effect sizes).
  • ACLR individuals showed smaller improvements on a hop test outcome compared to controls (large effect size).
  • No significant differences were found between ACLR legs, and test-retest reliability was excellent for the ACLR group (ICCs 0.74–0.97).

Conclusions:

  • The dual-task paradigm is feasible and preliminarily reliable for assessing individuals with ACLR.
  • Poorer performance and smaller improvements in the ACLR group suggest persistent dual-task deficits post-injury.
  • This paradigm offers a valuable tool for ecologically valid ACL rehabilitation and return-to-sport assessment.