Effect of ACL Reconstruction Recovery Timelines on Patient Reported Outcomes
Loading...
Presenter(s)
Alexa Hoffman, Nicole Kirscher, Alexis Partida
Abstract
Clinical Question: In patients that have undergone anterior cruciate ligament repair (ACL-R), what are the effects of accelerated rehabilitation versus conservative rehabilitation on patient-reported outcomes (PROs)?
Search Strategy: We searched the following electronic databases: PubMed, ScienceDirect, ProQuest, and Cochrane Library from 2000 to 2026 for all articles related to ACL-R rehabilitation timelines with the search terms: accelerated, aggressive, early, conservative, ACL rupture, rehabilitation, and ACL reconstruction. The reference list in selected articles was also reviewed for additional sources. Inclusion criteria were isolated ACL rupture, multiple rehabilitation protocols, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores. Exclusion criteria were ACL sprains, other ligamentous involvement, non-operative maintenance, and previous history of ACL tear. Eight articles met our criteria and were included in this review.
Evidence Quality Assessment: Articles were evaluated using the PEDro Scale and Oxford Level of Evidence. PEDro scores ranged from 5 to 8, indicating “fair” to “good” methodological quality. Oxford scores ranged from Level 2 to Level 3, indicating moderate to strong evidence.
Results and Summary of Search: In active individuals who underwent ACL-R, accelerated rehabilitation showed no significant differences compared with conservative protocols in IKDC and KOOS scores. One of three studies assessing KOOS and five of seven studies assessing IKDC scores reported no statistically significant differences (p = 0.06–0.88; p = 0.27–0.91). Strengths of the articles include consistent findings across graft types, clinically relevant populations, and high retention rates. Limitations include small sample sizes, short follow-up, protocol variability, compliance differences, and broad inclusion criteria.
Clinical Scenario: While traditional rehabilitation protocols have required 9-12 months before return to play, newer evidence suggests that accelerated rehabilitation may allow athletes to return as early as six months, which may raise safety and effectiveness concerns. The purpose of this study was to compare accelerated versus conservative ACL-R rehabilitation protocols in physically active individuals by evaluating differences in recovery and return to activity based on PROs.
Clinical Bottom Line: In active individuals who underwent ACL-R, accelerated rehabilitation showed no significant differences compared to conservative rehabilitation on PROs. The evidence supports a Strength of Recommendation Taxonomy grade B, indicating weak support for the intervention. Wide variability in PROs suggests recovery is highly individualized, with optimal rehabilitation timelines differing between patients. Clinically, these findings support a criteria-based, individualized rehabilitation approach rather than a strictly time-based progression.
Implications: This research continues to build support for more recent practices of limiting immobilization periods and having patients move as soon as safely possible. ACL-R rehabilitation protocols are continuously evolving based on new studies and surgical advancements. In the backdrop of athletics, the question will always be: how soon can we return the athlete to play? However, sometimes what is physically possible and what leads to the best long-term results for the patient are two different things. Future research should continue to focus on minimum acceptable ACL-R recovery timelines and longer follow-ups to examine knee instability, retear rates, and quality of life.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer
Second Advisor/Mentor
Blaine Birtzer
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Effect of ACL Reconstruction Recovery Timelines on Patient Reported Outcomes
Clinical Question: In patients that have undergone anterior cruciate ligament repair (ACL-R), what are the effects of accelerated rehabilitation versus conservative rehabilitation on patient-reported outcomes (PROs)?
Search Strategy: We searched the following electronic databases: PubMed, ScienceDirect, ProQuest, and Cochrane Library from 2000 to 2026 for all articles related to ACL-R rehabilitation timelines with the search terms: accelerated, aggressive, early, conservative, ACL rupture, rehabilitation, and ACL reconstruction. The reference list in selected articles was also reviewed for additional sources. Inclusion criteria were isolated ACL rupture, multiple rehabilitation protocols, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores. Exclusion criteria were ACL sprains, other ligamentous involvement, non-operative maintenance, and previous history of ACL tear. Eight articles met our criteria and were included in this review.
Evidence Quality Assessment: Articles were evaluated using the PEDro Scale and Oxford Level of Evidence. PEDro scores ranged from 5 to 8, indicating “fair” to “good” methodological quality. Oxford scores ranged from Level 2 to Level 3, indicating moderate to strong evidence.
Results and Summary of Search: In active individuals who underwent ACL-R, accelerated rehabilitation showed no significant differences compared with conservative protocols in IKDC and KOOS scores. One of three studies assessing KOOS and five of seven studies assessing IKDC scores reported no statistically significant differences (p = 0.06–0.88; p = 0.27–0.91). Strengths of the articles include consistent findings across graft types, clinically relevant populations, and high retention rates. Limitations include small sample sizes, short follow-up, protocol variability, compliance differences, and broad inclusion criteria.
Clinical Scenario: While traditional rehabilitation protocols have required 9-12 months before return to play, newer evidence suggests that accelerated rehabilitation may allow athletes to return as early as six months, which may raise safety and effectiveness concerns. The purpose of this study was to compare accelerated versus conservative ACL-R rehabilitation protocols in physically active individuals by evaluating differences in recovery and return to activity based on PROs.
Clinical Bottom Line: In active individuals who underwent ACL-R, accelerated rehabilitation showed no significant differences compared to conservative rehabilitation on PROs. The evidence supports a Strength of Recommendation Taxonomy grade B, indicating weak support for the intervention. Wide variability in PROs suggests recovery is highly individualized, with optimal rehabilitation timelines differing between patients. Clinically, these findings support a criteria-based, individualized rehabilitation approach rather than a strictly time-based progression.
Implications: This research continues to build support for more recent practices of limiting immobilization periods and having patients move as soon as safely possible. ACL-R rehabilitation protocols are continuously evolving based on new studies and surgical advancements. In the backdrop of athletics, the question will always be: how soon can we return the athlete to play? However, sometimes what is physically possible and what leads to the best long-term results for the patient are two different things. Future research should continue to focus on minimum acceptable ACL-R recovery timelines and longer follow-ups to examine knee instability, retear rates, and quality of life.
