Effectiveness of Home-Based Rehabilitation After Anterior Cruciate Ligament Construction in Comparison to Clinic-Based Rehabilitation: A Systematic Review

Abstract

The postoperative rehabilitation process following anterior cruciate ligament reconstruction (ACLR) plays a vital role in restoring the patient's range of motion (ROM) and thigh strength to a level comparable to their pre-injury state.

Purpose: This systematic review was conducted to examine the studies currently available comparing the effectiveness of home-based rehabilitation HBR protocols with clinic-based rehabilitation CBR protocols (ACLR) on ROM and quadriceps strength to find if there is a significant difference between both protocols to contribute to developing evidence-based rehabilitation programmes in this field.

Methods: we included patients with age from 18 to 45 underwent to ACLR with different type of grafts after isolated or complex injuries. All studies were randomised control trials RCTs. Studies that compared HB rehabilitation to CB rehabilitation were included. Studies that compared HB with different type of rehabilitation rather than CB in addition to trials on different knee injuries were excluded. Trials with different outcome measures and language also excluded. Databases were searched were Cochrane, PubMed, SPORTDiscus,, PEDro, and ScienceDirect from 1996 to April 2023. Risk of bias tool 2 RoB2 was used to assess the bias in the included studies. Patients sample sizes were 577.

Results: Eight studies were eligible. RoB 2 showed all trials were RCTs and at high- risk of bias except one with some concern. Generally no statistical significant difference found between both intervention in all trials included in ROM and quadriceps strength. Significant difference found in HB 97% vs PT 83% for extension as well as a significant difference in quadriceps strength between 3 months and 3 years was reported. Conclusions: Insufficient evidence is currently available to determine the efficacy of HBR programmes in comparison to CBR programmes. There is a necessity to undertake further research on enhancing the efficacy of HB rehabilitation interventions, specifically through the utilisation of different methods such as mobile applications to facilitate patient adherence.

Key Words: ACLR, EXERCISE, QUADRICEPS STRENGTH, SUPERVISED, ROM,UNSUPERVISED