In this study of 145 patients (16-59 years, 85 males and 60 female) participated in a randomized controlled clinical trail to compared the effectiveness of a home-based rehabilitation program (HBP, 73 patients) and a standard physical therapy-supervised rehabilitation program (PTP, 72 patients) in patients 3 month after nonacute anterior cruciate ligament reconstruction.
 
All patients attended a preoperative education session and baseline assessment within the 2 weeks before their ACL reconstruction surgeries.  Patients completed a quality-of-life questionnaire and were provided with a specific handouts to take home which contained all the information covered in the preoperative education session and the rehabilitation program.  The rehabilitation program consisted of four phases which each phase including home activities to perform, rehabilitation goals, knee immobilizers use, weight bearing, cryotherapy, stretching, strengthening, endurance activates, and proprioception.  The rehabilitation program had instruction on how to perform the exercises, number of sets and repetitions, exercise progression criteria and exercise precautions and pictures.  The exercises performed required minimal equipment (Cryo/Cuff, 3 pieces of elastic tubing of increasing resistance, wobble board). 

All patients followed up with their surgeon one to two weeks after surgery and began physiotherapy one week after surgery.  In the HBP group the physiotherapist informed patients of the rehabilitation process and reviewed the patients' progress with phase one exercise.  At the end of session one phase two exercises were introduced.  This was repeated over the next three sessions (end of 3, 6 12 weeks after surgery, 4 PT sessions over the first 12 weeks after surgery).  The PTH group began physiotherapy one week after surgery and attended physiotherapy 2 sessions per week for week two to seven and once per week for week 8 to 12 after surgery (17 over the first 12 weeks after surgery).  The PTP group was given the 12-week rehabilitation program and progressions was directed by the physical therapist but depended on the patient's ability to meet progression criteria.

All patients were evaluated three times; preoperatively, 6 weeks postoperatively and 12 weeks postoperatively.  Passive extension ROM, active-assisted knee flexion, sagittal plan knee laxity, knee joint angle during walking, evaluation of thigh strength (quadriceps and hamstrings).  The researchers felt that knee extension and flexion ROM were felt to be the most important measures of rehabilitation success in the first 3 months postoperatively as strength and quality of life would continuelying increase after the three months.

The conclusion of the study was the HBP had a significantly higher percentage of patients with acceptable flexion and extension range of motion compared to the PTP (flexion, 67% vs 47%; extension, 97% vs. 83%) while there was no significant difference between groups in ROM during walking, ligament laxity and strength.

For More Details: Grant, JG, Mohtadi, NG, Maitland, ME and Zernicke, RF. (2005) Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine 33: 1288-1297.

copyright © Rick Kaselj of Healing Through Movement

Article written by Rick Kaselj - rkaselj@healingthroughmovement.com

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