Supervised Rehabilitation May Lead to Better Outcome than Home-Based Rehabilitation Up to 1 Year after Anterior Cruciate Ligament Reconstruction.

Background and objectives: Previous studies consistently found no significant difference between supervised and home-based rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the function of the nonoperative knee, hamstring strength at deep flexion, and neuromuscular control have been overlooked. This prospective observational study was performed to investigate the outcomes after ACLR in operative and nonoperative knees between supervised and home-based rehabilitations. Materials and Methods: After surgery, instructional videos demonstrating the rehabilitation process and exercises were provided for the home-based rehabilitation group. The supervised rehabilitation group visited our sports medicine center and physical therapists followed up all patients during the entire duration of the study. Isokinetic muscle strength and neuromuscular control (acceleration time (AT) and overall stability index (OSI)) of both operative and nonoperative knees, as well as patient-reported knee function (Lysholm score), were measured and compared between the two groups 6 months and 1 year postoperatively. Results: The supervised rehabilitation group showed higher muscle strength of hamstring and quadriceps in nonoperative knees at 6 months (hamstring, p = 0.033; quadriceps, p = 0.045) and higher hamstring strength in operative and nonoperative knees at 1 year (operative knees, p = 0.035; nonoperative knees, p = 0.010) than the home-based rehabilitation group. At 6 months and 1 year, OSIs in operative and nonoperative knees were significantly better in the supervised rehabilitation group than in the home-based rehabilitation group (operative knees, p < 0.001, p < 0.001; nonoperative knees, p < 0.001, p < 0.001, at 6 months and 1 year, respectively). At 1 year, the supervised rehabilitation group also demonstrated faster AT of the hamstrings (operative knees, p = 0.016; nonoperative knees, p = 0.036). Lysholm scores gradually improved in both groups over 1 year; however, the supervised rehabilitation group showed higher scores at 1 year (87.3 ± 5.8 vs. 75.6 ± 15.1, p = 0.016). Conclusions: This study demonstrated that supervised rehabilitation may offer additional benefits in improving muscle strength, neuromuscular control, and patient-reported knee function compared with home-based rehabilitation up to 1 year after ACLR.

Effectiveness of modeling videos on psychological responses of patients following anterior cruciate ligament reconstruction: A pilot randomized trial.

BACKGROUND: To date, much of the rehabilitation following anterior cruciate ligament reconstruction (ACLR) has centered on physical components. However, clinical outcomes including return to sport after ACLR depends on not only physical recovery but also psychological components. This study was performed to assess the feasibility of 6-month modeling video intervention on psychological responses following ACLR. METHODS: Following the baseline assessment of psychological measures through Knee Self Efficacy Scale (K-SES), ACL-Return to Sport after Injury (ACL-RSI), and Tampa Scale of Kinesiophobia-11 (TSK-11), 32 patients scheduled for ACLR were randomly assigned to intervention (n = 10), placebo (n = 11), or control (n = 11) group. Six modeling videos and placebo videos were developed by the investigators. Intervention and placebo groups watched their respective videos during their follow-up visits while control group did not. All groups completed psychological assessments during hospitalization, at 2 weeks, at 6 weeks, at 3 months, and at 6 months following ACLR. Also, Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate symptoms and function of the knee at 3 and 6 months after surgery. RESULTS: No significant changes in K-SES, ACL-RSI, and TSK-11 scores over 6-month period were observed among groups (P = .808, P = .574, P = .888, respectively). Compared with baseline, only the scores of K-SES improved with statistical significance in the intervention, placebo, and control groups (P = .05, .01, .00) at 6 months after ACLR. The KOOS subscale scores were not significantly different among the intervention, placebo, and control groups at 3 and 6 months. CONCLUSION: A modeling video intervention, although feasible, was not effective in addressing the psychological risk factors in patients undergoing ACLR.