Discussion
ACL injuries, ACL, abnormal gait, muscle bulk atrophy, fibrosis, pain, muscular reflex, decreases its proprioceptive ability, knee effusion, effusion, TG
MUSCLE ATROPHY, FIBROSIS, NEUROMUSCULAR INHIBITION, JOINT EFFUSION, EFFUSION, COMPLICATIONS
Due to the growing number of people with ACL injuries and their urgent need for post-operative rehabilitation, numerous clinicians are seeking to develop new protocols to accelerate the rehabilitation process. With its board and exergames, Wii Fit could offer enjoyable training and accurate feedback to improve the outcomes. A new exergame protocol based on the expert system has been proposed to accelerate the ACLR rehabilitation process in the study.In the proposed ES, after entering the data and initial calculations, a proper rehabilitation program was presented in the format of ten Wii Fit exercises with their repetition, duration of each exercise, and difficulty level. Reducing waste of time is one of its most important advantage over conventional approaches. The patient could receive a training regimen from the ES without the need for constant attendance of therapists. With the ES increasing accessibility, the insights of the best experts are provided to the user anywhere and anytime through the computer. In the present research, the effectiveness of ES-based Wii Fit protocols on pain, knee effusion, TG, KFR, physical function, balances compared to the conventional rehabilitation outcomes in the patients following ACLR.Pain is one of the annoying complications after ACL reconstructive surgery that might be endured for months. Persistent pain often leads to neuromuscular inhibition, muscle atrophy, and reduction of knee ROM [Joint effusion is seen in most patients after ACLR which causes several complications loss of motion, neuromuscular inhibition, muscle atrophy, decreasing postural stability, and abnormal gait [The measurement of TG is commonly used to assess thigh muscle bulk atrophy. According to our findings, TG demonstrated no significant difference between the two groups similar to Karakoc et al. [Loss of mobility is one of the undesirables of ACL reconstructive surgery caused by pain, surgery, effusion, inactivity, periarticular tissue fibrosis, adaptive shortening of muscles, and so on [Hopping tests are among the most important functional assessments after ACLR with high validity and reproducibility in healthy and reconstructed knees [ACL plays a vital role as a sensory organ supplying proprioceptive data that initiates a protective muscular reflex. Reconstruction of ACL decreases its proprioceptive ability and impairs balance. ACL is responsible for the diagnosis of joint position, kinesthesia, and equilibrium. Equilibrium is a complex interaction between sensory perceptions and motor responses [Our findings revealed a significant improvement in the stability scores in the static BESS test in the Wii group. Karakoc et al. have gained no significant difference in the postural sways between the control and virtual rehabilitation group [This study applied the modified SEBT test in the anterior, posteromedial, and posterolateral directions to evaluate the dynamic balance. Significant differences exist between the groups in all directions of the modified SEBT test. So far, no scientific evidence supports the positive effect of exergames with Wii Fit on dynamic balance, especially after ACLR. However, based on our findings, it seems that exercise-therapy with Wii Fit using ES is an effective approach to improve the dynamic stability in ACL-reconstructed athletes.The finding of the present study also showed that the Wii Fit exergaming was very pleasant for the participants in the Wii group, and the patients' motivation to exercise was much higher and they participate eagerly in rehabilitation programs which were very encouraging for the researchers, besides, no dissatisfaction or side effects were reported by the patients. Wii Fit exergames therapy with an ES exclusively for use in rehabilitation clinics can improve patients' function, save time and resources. Besides, during COVID-19 pandemics, patients can receive their rehabilitation program by the ES and do it alone via Wii Fit.