The Effect of Duration of Supervised Rehabilitation on Outcomes Following Anterior Cruciate Ligament Reconstruction:...

Rehabilitation practices and recovery timelines are variable following anterior cruciate ligament reconstruction (ACLR). Elucidating associations between longitudinal temporal characteristics of rehabilitation and relevant functional outcomes following ACLR may help with improving outcomes and reducing re-injury risk.

The purpose of this systematic review was to analyze the effect of the duration of supervised rehabilitation on strength, functional performance, and self-reported outcomes following ACLR.

A systematic review was conducted in the PubMed, Embase, Scopus, CINAHL, and Pedro databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search terms included terms pertaining to diagnosis (e.g., 'anterior cruciate ligament', 'ACL reconstruction'), rehabilitation (e.g., 'rehabilitation', 'physiotherapy', 'physical therapy'), and outcomes (e.g., 'functional status', 'return to sport', 'return to play'). Inclusion criteria were studies that 1) included patients who had undergone primary ACLR, 2) reported outcome measures of strength, physical performance testing (such as hop testing), and/or patient reported functional status, and 3) measurements of the duration of supervised rehabilitation following ACLR. Exclusion criteria included a lack of direct statistical comparison of the effect of rehabilitation duration on outcome measures, studies that were not available in full-text in the English language, or studies that were later retracted. The Downs and Black checklist was implemented to assess the quality of the studies included, and risk of bias was assessed with the ROBINS-I tool.

Out of 5598 studies initially retrieved, 44 underwent full-text screening and nine studies (one randomized controlled trial, one retrospective cohort, and seven cross-sectional studies) met inclusion criteria and were included in this study. These studies showed trends for higher knee strength, improved performance testing, and greater self-reported outcomes with a longer duration of rehabilitation. There was considerable variety in the duration assessed and time points for when the outcomes were measured.

Limited quality evidence exists to support supervised rehabilitation of at least six months in duration following ACLR for knee strength, performance testing, and patient-reported functional outcomes.

Level 3.