The Effect of Duration of Supervised Rehabilitation on Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review.
William H Suits, Nia I Ahart, Zoey A Humes
Longer supervised rehabilitation (six months or more) was associated with better strength, performance, and return-to-sport outcomes in seven of nine studies, but the only randomised trial found no difference and every study had moderate or serious risk of bias.
Key findings
1Seven of the nine included studies found a statistically significant association between longer supervised rehabilitation and at least one outcome (strength, performance, or self-reported function).
2The only randomised trial (n = 42; 4.4 vs 7.4 months of supervised rehabilitation) found no significant differences in IKDC, Tegner, hop, or knee strength outcomes.
3No study in the review found evidence that outcomes worsened with longer supervised rehabilitation.
Still to come
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Participants were 68.6% male with a mean age of 27.6 years, so the findings say little about female athletes or adolescents, who are at higher re-injury risk and recover more slowly. All nine studies carried moderate or serious risk of bias; eight of the nine were cross-sectional or retrospective, so none can establish that longer rehab caused better outcomes. The single randomised trial did not account for participants lost to follow-up, weakening its internal validity. The content of the rehabilitation was minimally described or not described at all in most studies, so it is unclear what the extra months actually involved. The timing of outcome assessments relative to surgery varied widely across studies (from 4 months to over 44 months), making it hard to compare results. Hamstring autografts were disproportionately represented, limiting generalisability to patients who receive bone-patellar tendon or allograft reconstructions.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read this as proof that six months of supervised rehabilitation is the correct duration for every ACLR patient. The only randomised trial found no significant difference between 4.4 and 7.4 months, and all eight observational studies that did show a benefit carried moderate or serious risk of bias, so the association may reflect confounding rather than a causal effect of time in the clinic.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →