Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction: a randomized clinical trial.
BACKGROUND
Because of health care funding and policy changes, there is a need to examine the effects of an evolution toward patient-directed (ie, home-based) rehabilitation programs on clinical outcomes of patients undergoing anterior cruciate ligament reconstruction.


OBJECTIVE
There will be no difference in the effectiveness of a home-based rehabilitation program and a standard physical therapy-supervised rehabilitation program in patients 3 months after nonacute anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts.


METHODS
Randomized controlled clinical trial; Level of evidence, 1.


METHODS
There were 145 patients (16-59 years) who attended a presurgery education class. Home-based patients attended 4 physical therapy sessions, and physical therapy-supervised patients attended 17 physical therapy sessions over the first 12 weeks after surgery. All patients followed the same standardized rehabilitation program. Study outcome measures included active-assisted knee flexion and passive knee extension range of motion, knee range of motion during walking, KT computerized arthrometer results, and isokinetic quadriceps and hamstrings strength. Patient outcomes were dichotomized as either clinically acceptable or unacceptable. Rehabilitation programs were compared by the proportion of acceptable patients in each group.


RESULTS
The home-based group had a significantly higher percentage of patients with acceptable flexion and extension range of motion compared to the standard physical therapy group (flexion, 67% vs 47%; extension, 97% vs 83%). There were no significant differences between the groups in range of motion during walking, ligament laxity, and strength.


CONCLUSIONS
A structured, minimally supervised rehabilitation program was more effective in achieving acceptable knee range of motion in the first 3 months after anterior cruciate ligament reconstruction than a standard physical therapy-based program.


CONCLUSIONS
Recreational athletes undergoing nonacute anterior cruciate ligament reconstruction can successfully reach acceptable rehabilitation goals in the first 3 months after surgery with a limited number of purposeful physical therapy education sessions, allowing recreational athletes more flexibility when integrating the necessary postoperative rehabilitation into their daily activities.
Grant
John A
JA
Sport Medicine Centre, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada. grantja@ucalgary.ca
Mohtadi
Nicholas G H
NG
Maitland
Murray E
ME
Zernicke
Ronald F
RF
D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012421:Rupture; D016896:Treatment Outcome