[Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients].
OBJECTIVE
The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique.


METHODS
This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively.


RESULTS
There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered when interpreting the results.


CONCLUSIONS
This is the first report comparing inpatient and outpatient rehabilitation protocols after anterior cruciate ligament reconstruction. The only reports in the literature have compared different ambulatory rehabilitation programs that appear to be internationally accepted as the routine procedure. The current trend towards short hospital stays for surgery is compatible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for anterior cruciate ligament reconstruction is compatible with an outpatient rehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those obtained after inpatient programs conducted in a rehabilitation facility during the first postoperative month.
Rousseau
B
B
18 bis, rue Fouré, 44000 Nantes. bertrand.rousseau@nantes-mpr.com
Dauty
M
M
Letenneur
J
J
Sauvage
L
L
De Korvin
G
G
D000203:Activities of Daily Living; D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D005684:Gait; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology; D012421:Rupture; D013180:Sprains and Strains / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery