Intensive supervised rehabilitation versus less supervised rehabilitation following anterior cruciate ligament reconstruction? A systematic review and meta-analysis

Gamble, Andrew R.; Pappas, Evangelos; O’Keeffe, Mary; Ferreira, Giovanni E; Maher, Christopher G.; Zadro, Joshua R

doi:10.1016/j.jsams.2021.03.003

Cited by 10 publications

(7 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two reviews (total of seven RCTs) evaluated structured in-person rehabilitation (ie, regular supervised rehabilitation plus home exercises) versus structured home-based rehabilitation (ie, regular unsupervised home-based exercises with occasional supervised sessions) following ACL tear and reconstruction. Both reviews concluded that structured in-person rehabilitation (range of 14–36 physiotherapy visits over 2–9 months) was generally not superior to structured home-based rehabilitation (range of 3–17 physiotherapy visits over 2–9 months) for range of motion, quadriceps and hamstring muscle strength, knee laxity and functional (self-reported and physical) outcomes both in the short-term and long-term (ie, up to 2 years) post-injury/surgery 40 43. The certainty of evidence for all outcomes from the most recent and highest quality review was low to moderate 40…”

Section: Resultsmentioning

confidence: 99%

“…Both reviews concluded that structured in-person rehabilitation (range of 14–36 physiotherapy visits over 2–9 months) was generally not superior to structured home-based rehabilitation (range of 3–17 physiotherapy visits over 2–9 months) for range of motion, quadriceps and hamstring muscle strength, knee laxity and functional (self-reported and physical) outcomes both in the short-term and long-term (ie, up to 2 years) post-injury/surgery 40 43. The certainty of evidence for all outcomes from the most recent and highest quality review was low to moderate 40…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two systematic reviews including 142 primary RCTs were included in this review (figure 1). 25–46 These systematic reviews were published between 2004 and 2021, included mostly male participants (56%–95% men) and focused almost exclusively on ACLR populations (table 1). No systematic reviews evaluating interventions following isolated meniscal injury in persons with a mean age of ≤30 years were identified.…”

Section: Resultsmentioning

confidence: 99%

“…40 43 The certainty of evidence for all outcomes from the most recent and highest quality review was low to moderate. 40…”

Section: Reviewmentioning

confidence: 99%

See 3 more Smart Citations

Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

et al. 2022

View full text Add to dashboard Cite

ObjectiveSynthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes.DesignOverview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence.Data sourcesMEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.Eligibility criteriaSystematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults.ResultsWe included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion.ConclusionThe general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…40 43 The certainty of evidence for all outcomes from the most recent and highest quality review was low to moderate. 40…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

et al. 2022

View full text Add to dashboard Cite

show abstract

“…2 11-20 It is also based on studies that have failed to demonstrate superior outcomes with many supervised physiotherapy sessions compared with few (or no) supervised physiotherapy sessions for some musculoskeletal conditions. [21][22][23][24][25][26][27] The REFORM trial is a single-blind, pragmatic, randomised, controlled, non-inferiority trial. Two hundred and ten participants are being recruited from five public hospitals in areas of Sydney that have culturally and socioeconomically diverse populations.…”

Section: Open Accessmentioning

confidence: 99%

Protocol for a process evaluation: face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: the REFORM trial

et al. 2022

View full text Add to dashboard Cite

IntroductionThe REFORM (REhabilitation FOR Musculoskeletal conditions) trial is a non-inferiority randomised controlled trial (n=210) designed to determine whether a supported home exercise programme is as good or better than a course of face-to-face physiotherapy for the management of some musculoskeletal conditions. The trial is currently being conducted across Sydney government hospitals in Australia. This process evaluation will run alongside the REFORM trial. It combines qualitative and quantitative data to help explain the trial results and determine the feasibility of rolling out supported home exercise programmes in settings similar to the REFORM trial.Methods and analysisTwo theoretical frameworks underpin our process evaluation methodology: the Realist framework (context, mechanism, outcomes) considers the causal assumptions as to why a supported home exercise programme may be as good or better than face-to-face physiotherapy in terms of the context, mechanisms and outcomes of the trial. The RE-AIM framework describes the Reach, Effectiveness, Adoption, Implementation and Maintenance of the intervention. These two frameworks will be broadly used to guide this process evaluation using a mixed-methods approach. For example, qualitative data will be derived from interviews with patients, healthcare professionals and stakeholders, and quantitative data will be collected to determine the cost and feasibility of providing supported home exercise programmes. These data will be analysed iteratively before the analysis of the trial results and will be triangulated with the results of the primary and secondary outcomes.Ethics and disseminationThis trial will be conducted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2018) and the Note for Good Clinical Practice (CPMP/ICH-135/95). Ethical approval was obtained on 17 March 2017 from the Northern Sydney Local Health District Human Research Ethics Committee (trial number: HREC/16HAWKE/431-RESP/16/287) with an amendment for the process evaluation approved on 4 February 2020. The results of the process evaluation will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.Trial registration numberACTRN12619000065190.

show abstract

Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes

Slawaska-Eng

Yee

Kruse

et al. 2023

Knee Arthroscopy and Knee Preservation Surgery

View full text Add to dashboard Cite

Intensive supervised rehabilitation versus less supervised rehabilitation following anterior cruciate ligament reconstruction? A systematic review and meta-analysis

Cited by 10 publications

References 42 publications

Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

Protocol for a process evaluation: face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: the REFORM trial

Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes

Contact Info

Product

Resources

About