Effects of Postoperative Physiotherapy Supervision Duration on Clinical Outcome, Speed, and Agility in Males 8 Months After Anterior Cruciate Ligament Reconstruction

Abstract

BackgroundWe investigated whether the duration of postoperative physiotherapy supervision by a physiotherapist affects clinical outcome, speed, and agility in males 8 months after anterior cruciate ligament reconstruction (ACLR).Material/MethodsFrom a group of 248 patients 8 months after ACLR, we used strict exclusion criteria to identify 2 groups of men who were well trained and frequently participated in sports pre-injury, with different durations of postoperative physiotherapy supervision: Group I (n=15; x=27.40 weeks) and Group II (n=15; x=8.07 weeks). Group III (n=30) were controls. Clinical evaluation (manual ligament assessment, knee joint and thigh circumferences, range of motion), pain assessment, and run test with maximal speed and change-of-direction manoeuvres, was performed.ResultsNo clinically significant abnormalities were noted in any studied groups in terms of clinical and pain assessments. The time of the run test was significantly increased in Group II (x=23.77 s) compared with Group I (x=21.76 s) and Group III (x=21.15 s). The average speed was significantly reduced in Group II (x=2.05 m*s−1) compared with Group I (x=2.22 m*s−1) and Group III (x=2.27 m*s−1). The duration of physiotherapy supervision was significantly negatively correlated with the time results of the run test (r=−0.353; p=0.046) and positively correlated with the average speed (r=0.360; p=0.049).ConclusionsBoth shorter and longer duration of postoperative physiotherapy supervision resulted in successful clinical outcomes in terms of studied features in males 8 months after ACLR. Nevertheless, longer physiotherapy supervision was more effective for improving speed and agility to the level of healthy individuals.

The Influence, Barriers to and Facilitators of Anterior Cruciate Ligament Rehabilitation Adherence and Participation: a Scoping Review

“…All studies compared a group of patients who completed a shorter duration of supervised rehabilitation (less than 3 or 6 months) to a group of patients who completed six or more months of rehabilitation, including structured agility, gym exercises, landing and on-field rehabilitation in line with current evidence-based recommendations Supervised rehabilitation longer than 6 months was associated with improved outcomes at all assessment time points. Specifically, associations were found between longer supervised rehabilitation and functional symmetry [50,51], a greater likelihood of meeting return to sport criteria and RTS at 12 months [50,51], double leg vertical hop landing symmetry [52,53], knee flexor rate of torque development and symmetry [54], speed and agility [55], knee extensor muscles torque parameters and LSI values [56] and better subjective outcomes [57]. Delaying the start of rehabilitation longer than one month after reconstruction was negatively associated with objective outcomes [57].…”

“…Delaying the start of rehabilitation longer than one month after reconstruction was negatively associated with objective outcomes [57]. However, the duration of supervised rehabilitation was not associated with one leg vertical hop symmetry [53], knee joint stability, thigh and knee joint circumferences, active range of motion or everyday pain [55].…”

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

“…According to the opinion of some authors discussing the issue in the past, a minimally supervised postoperative physiotherapeutic procedure is cost saving [10] and can result in successful ACL rehabilitation [7,10,35,36]. This opinion has been changing [11,12]. There are studies indicating better outcomes in terms of speed and agility in patients eight months postoperatively, who underwent a physiotherapeutic procedure at a rehabilitation center and were directly supervised by a physiotherapist for at least six months after ACLR, compared to the patients with a shorter postoperative physiotherapy supervision [12].…”

“…This opinion has been changing [11,12]. There are studies indicating better outcomes in terms of speed and agility in patients eight months postoperatively, who underwent a physiotherapeutic procedure at a rehabilitation center and were directly supervised by a physiotherapist for at least six months after ACLR, compared to the patients with a shorter postoperative physiotherapy supervision [12]. In other studies, in patients following supervised physiotherapy for less than six months postoperatively, the two-legged landing limb symmetry was worse than that in the patients receiving fully supervised physiotherapy for at least six months, and worse than that in healthy individuals, indicating that fully supervised postoperative physiotherapy is more effective for improving two-legged vertical jump landing limb symmetry eight months after ACLR [27].…”

“…In the literature, there are a large number of standardized postoperative protocols after ACLR; however, there is still no consensus regarding postoperative physiotherapeutic procedure without the direct supervision of a physiotherapist; this procedure is called unsupervised or partially supervised physiotherapy [3][4][5][6]. Since the 1990s, there has been a general assumption that unsupervised physiotherapy after ACLR produces results equal to those obtained with supervised physiotherapy [7][8][9][10]; however, the assumption has been changing [11,12].…”