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

## TL;DR

A new test was developed to assess cognitive and motor skills in athletes recovering from ACL injuries, showing potential for better return-to-sport evaluations.

## Contribution

A novel dual-task paradigm was introduced to evaluate cognitive-motor performance in ACL-reconstructed individuals.

## Key findings

- ACLR individuals showed significantly worse performance than controls in retest sessions.
- The dual-task paradigm demonstrated excellent test-retest reliability for ACLR participants.
- Persistent dual-task deficits were observed in ACLR individuals, suggesting its utility for rehabilitation assessment.

## Abstract

Current return‐to‐sport screening paradigms after anterior cruciate ligament (ACL) injury are inadequate as they fail to reflect cognitive‐motor sports demands. This pilot study aimed to evaluate dual‐task ability in individuals with ACL reconstruction (ACLR) using a novel dual‐task test paradigm. Specifically, we compared (1) cognitive and motor performance between individuals with ACLR and controls, (2) hop test performance between the injured and non‐injured legs within the ACLR group, and (3) performance across test‐retest sessions.

Twenty sports active individuals (10 ACLR, 10 controls) performed the dual‐task paradigm twice within a week, comprising a cognitive test, a dual‐task drop‐vertical hop test, and an upper‐body hand‐tapping test. All tests incorporated a visuospatial working‐memory task (cognitive performance), with the latter two additionally engaging attention, decision‐making, and inhibitory control (motor performance). Between‐group, between‐leg, and test‐retest differences were analyzed using independent and paired t‐tests with Cohen’s d effect sizes (ESs). Test–retest reliability was examined using intraclass correlation coefficient (ICC), along with the within‐person standard deviation and minimal detectable change.

No significant differences were observed between ACLR and controls at the first test session (p = 0.09 − 0.34; ESs = 0.19–0.62 [very small–medium]), although ACLR mean performances were 3.8%–14.1% lower. At retest, ACLR performed significantly worse than CTRL for most outcomes (p = 0.01 − 0.03; ESs = 0.91–1.17 [large]) and showed smaller improvements for a hop test outcome (p = 0.04; ES = 0.97 [large]). No differences were found between ACLR legs, both groups improved across test sessions, and test–retest reliability was excellent for ACLR (ICCs = 0.74–0.97) and ranged from poor to excellent in CTRL (ICCs = 0.19–0.86).

This pilot study demonstrates the feasibility and preliminary reliability of the dual‐task paradigm, particularly within the ACLR group. Poorer cognitive, hop, and upper‐body test performances and smaller test–retest improvements for the ACLR group suggest persistent dual‐task deficits following injury, supporting the paradigm’s utility for ecologically valid ACL rehabilitation and return‐to‐sport assessment.