Physiotherapy-guided versus home-based, unsupervised rehabilitation in isolated anterior cruciate injuries following surgical reconstruction.

Abstract

The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized, supervised, physiotherapy-guided rehabilitation programme and a group of patients who followed an unsupervised, home-based rehabilitation programme. Forty patients with isolated anterior cruciate ligament injuries were allocated to either a supervised physiotherapy intervention group or home-based exercise group. Patients were investigated by an independent examiner pre-operative, 3, 6, 9 and 12 months post-surgery using the following outcome measures: Lysholm Score and Tegner Activity Scale, functional hopping tests, and isometric and isokinetic strength assessments. Both groups improved significantly (P = 0.01-0.04) following 12 months after surgery. The median Lysholm score increased from 57 (34-90) to 94 (90-100) in the supervised group and 60 (41-87) to 97 (95-100) in the unsupervised group. The median Tegner Activity Scale increased from 3 (2-8) to 6 (3-8) in the supervised group and 4 (2-8) to 5 (3-10) in the unsupervised group. The combined mean symmetry indices for the hopping tests improved from 77.3 ± 18.7 to 86.8 ± 11.1 (supervised) and from 78.1 ± 30.5 to 88.3 ± 10.9 (unsupervised). Isometric and isokinetic strength symmetry indices for knee extension improved from 68.9 ± 23.5 to 82.8 ± 11.9, respectively, 63.7 + 22.8 to 82.7 + 15.1 in the supervised group and from 73.6 ± 20.5 to 76.5 ± 17.9, respectively, 69.5 ± 24.3 to 76.9 ± 16.9 in the unsupervised group. Eccentric strength symmetry indices for knee extension improved from 67.9 ± 27.7 to 87.8 ± 6.8 in the supervised group and from 71.3 ± 17.8 to 82.6 ± 15.6 in the unsupervised group. This study could not demonstrate a benefit in a rehabilitation programme supervised by a physiotherapist in our population compared to an unsupervised cohort.