Effectiveness of digital health technologies in postoperative rehabilitation following anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

PURPOSE: To evaluate the effectiveness of digital health technology (DHT) in postoperative rehabilitation following anterior cruciate ligament reconstruction (ACLR) and to explore intervention characteristics influencing outcomes.

METHODS

Seven databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed, CNKI and Wan Fang) were searched from inception to 15 March 2025 for randomized controlled trials on DHT (e.g., wearable devices, virtual reality, robotics) for ACLR rehabilitation. Outcomes included rehabilitation adherence, knee function, proprioception, muscle strength, walking ability and pain. Meta-analysis using a random effects model was conducted to determine the standardized mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs).

RESULTS

This review included 16 RCTs with a total of 1064 ACLR patients. The meta-analysis results indicated that DHT improved rehabilitation adherence (SMD = 0.29, 95% CI = 0.02-0.56, p = 0.04), pain (SMD = -0.79, 95% CI = -1.38 to -0.19, p = 0.009), proprioception (MD = -0.99, 95% CI = -1.47 to -0.50, p < 0.0001), muscle strength (extensor peak torque: MD = 11.43, 95% CI = 6.26-16.61, p < 0.0001; flexor peak torque: MD = 12.03, 95% CI = 6.54-17.52, p < 0.0001) and walking ability (MD = 0.41, 95% CI = 0.32-0.49, p < 0.00001). Subgroup analyses indicated that virtual reality-based DHT improved knee function (MD = 3.88, 95% CI = 0.95-6.81, p = 0.010). Short-term interventions (<3 months) showed greater efficacy in functional recovery (MD = 3.57, 95% CI = 0.93-6.20, p = 0.008).

CONCLUSION

DHT is a feasible and effective approach for post-ACLR rehabilitation. Our findings demonstrate that DHT enhances adherence, improves knee function and alleviates pain, and restores muscle strength, proprioception and walking ability. These results support the integration of DHT into standardized rehabilitation protocols for ACLR patients.

LEVEL OF EVIDENCE: Level IV.