title: How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry.
abstract: BACKGROUND
  Preoperative knee function is associated with successful postoperative outcome after anterior cruciate ligament reconstruction (ACLR). However, there are few longer term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care.
  
  
  OBJECTIVE
  To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care.
  
  
  METHODS
  We included patients aged 16-40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) of 84 patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation (NAR) cohort) were compared with the scores of 2690 patients from the Norwegian National Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery and cartilage/meniscus injury at ACLR.
  
  
  RESULTS
  The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, activities of daily living (ADL), Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7-94% of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4-75.8% of the patients in the NKLR.
  
  
  CONCLUSIONS
  Patients in a prospective cohort who underwent progressive preoperative and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 years postoperatively compared to patients in the NKLR who received usual care.
authors.affiliation: Norwegian Research Center for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Grindem
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
authors.forename: L P
authors.initials: LP
authors.lastname: Granan
authors.affiliation: Norwegian Research Center for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
authors.forename: M A
authors.initials: MA
authors.lastname: Risberg
authors.affiliation: Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.
authors.forename: L
authors.initials: L
authors.lastname: Snyder-Mackler
authors.affiliation: Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
authors.forename: I
authors.initials: I
authors.lastname: Eitzen
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation*; D008297:Male; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL