Intensity of physiotherapy after anterior cruciate ligament reconstruction: a comparison of two rehabilitation regimen.

Background: Rehabilitation is one of the most critical points after anterior cruciate ligament (ACL) reconstruction. However, the recent trend of low-cost, short-term hospitalization makes sufficient rehabilitation after ACL reconstruction difficult.
Level of Evidence Iii: 34 patients who underwent non-anatomical single bundle ACL reconstruction using a hamstring auto graft were evaluated. Twenty patients (12 males and 8 females) were transferred to a special rehabilitation hospital (RH hospital group) after operation and concentrated rehabilitation was performed up to 4 h per day. Fourteen (9 males and 5 females) patients performed clinic-based rehabilitation at a university hospital three times per week (clinic group). Strength of quadriceps and knee flexion muscles was assessed at 60 degrees /s using a Cybex II dynamometer (Lumex, Ronkonkoma, NY, USA) at 3, 6 and 9 months after ACL reconstruction. Anterior tibial translation (ATT) and pivot shift test were also evaluated.
Results: No significant difference in muscle recovery in the lower extremity was observed at any time point after ACL reconstruction between the clinic group and the RH hospital group. However, 3 months after operation, the average muscle strength of the RH hospital group tended to be higher than that of the clinic group. There was no significant difference in ATT or pivot shift (each group included 4 positive pivot shift subjects) in the patients who were tested between the clinic group and the RH hospital group.
Conclusion: Concentrated rehabilitation at a rehabilitation hospital after ACL reconstruction has the potential to improve muscle strength in the lower extremities more dramatically in the early stages of post operation. However, the initial benefits of intensive physiotherapy disappear after 6 months.