title: Increased Compliance With Supervised Rehabilitation Improves Functional Outcome and Return to Sport After Anterior Cruciate Ligament Reconstruction in Recreational Athletes.
abstract: BACKGROUND
  Successful return to sport is an important outcome measure after anterior cruciate ligament (ACL) reconstruction and a reason for patients' decisions to elect surgery. Rehabilitation programs supervised by physical therapists are routinely prescribed after ACL reconstruction surgery. However, the added advantage of supervised physical therapy after ACL reconstruction is still debatable.
  
  
  OBJECTIVE
  Attending more supervised physical therapy sessions after arthroscopic ACL reconstruction in recreational athletes increases their chance of successful return to sport.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  The authors analyzed 93 recreational athletes who underwent arthroscopic ACL reconstruction. After arthroscopic single-bundle ACL reconstruction, patients were advised to attend 20 supervised physical therapy sessions. Patients' demographics, surgical details, and outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm scale, and Short Form-36 Health Survey [SF-36]) were recorded presurgery and at 1-year follow-up. Ability to return to sports was documented through patients' self-report. The attendance at physical therapy by each patient was obtained by examining database records and assessed as fully compliant (>15 sessions), moderately compliant (6-15 sessions), or noncompliant (<6 sessions).
  
  
  RESULTS
  Patients in the fully compliant group had significantly greater odds (odds ratio [OR], 18.5; 95% CI, 1.9-184.5; P = .013) of a successful return to sport as compared with the noncompliant group. Patients in the moderately compliant group also had greater odds of returning to sport as compared with the noncompliant group (OR, 4.2; 95% CI, 1.0-16.6; P = .043). Patients in the fully compliant group had significantly greater scores on the Lysholm (P < .001), KOOS Sports and Recreation subscale (P = .021), KOOS Symptoms subscale (P = .040), and SF-36 physical component summary (PCS) (P = .012) as compared with the noncompliant group. Moderately compliant patients had significantly greater scores on the Lysholm (P = .004), KOOS Sports and Recreation (P = .026), KOOS Symptoms (P = .041), KOOS Quality of Life (P = .022), and SF-36 PCS (P = .004) as compared with noncompliant patients.
  
  
  CONCLUSIONS
  In recreational athletes, moderate to full compliance with a supervised physical therapy program predicts improved knee function and a greater chance of returning to sport 1 year after ACL reconstruction.
authors.affiliation: National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore.
authors.forename: Fucai
authors.initials: F
authors.lastname: Han
authors.affiliation: Department of Rehabilitation, National University Hospital Sports Centre, National University Health System, Singapore.
authors.forename: Anirban
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.affiliation: National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore.
authors.forename: Lingaraj
authors.initials: L
authors.lastname: Krishna
keywords: anterior cruciate ligament reconstruction; compliance with physical therapy; physical therapy; return to sports