Field Applicability of Cognitive–Motor Dual-Task Assessment in Anterior Cruciate Ligament Rehabilitation: A Systematic Review of Psychometric, Physiological, and Translational Frameworks

Background: Anterior cruciate ligament rehabilitation increasingly emphasizes the integration of cognitive and motor recovery. Traditional strength or balance tests fail to capture attentional control and movement coordination under cognitive load. Cognitive–motor dual-task paradigms address this gap, yet existing studies are fragmented by heterogeneous designs and limited psychometric validation. This review proposes a structured four-component framework—comprising cognitive task, sensor modality, outcome metric, and protocol standardization—to unify assessment approaches and enhance clinical applicability.Methods: A systematic narrative synthesis was performed across PubMed, Scopus, and Web of Science (2010–2025). Thirty-seven studies employing cognitive–motor dual-task paradigms in anterior cruciate ligament or anterior cruciate ligament reconstruction contexts were analyzed. Evidence was categorized into behavioral, kinematic, and physiological domains, focusing on psychometric properties including validity, reliability, responsiveness, and feasibility for clinical translation.Results: Dual-task conditions consistently revealed prolonged reaction time, higher error rates, and asymmetrical movement patterns undetected by single-task tests. Wearable technologies, including inertial measurement units and smart insoles, achieved near-laboratory validity and rapid setup. Behavioral measures demonstrated strong reliability, whereas physiological modalities such as electroencephalography, functional near-infrared spectroscopy, heart rate variability, and electrodermal activity provided mechanistic insights with variable reproducibility.Conclusions: This review advances dual-task assessment from exploratory research to a psychometrically grounded clinical framework. By integrating behavioral, kinematic, and physiological measures, it defines a wearable-based strategy that connects laboratory precision with field feasibility. Future priorities include multicenter validation, creation of normative datasets and clinical thresholds, and establishment of open-data infrastructures to ensure reproducibility. Standardized, psychometrically rigorous dual-task assessment may become a core tool for individualized rehabilitation and safe return to sport.