Isokinetic Knee Muscle Strength Following Anterior Cruciate Ligament Reconstruction in Adolescent Patients: A Comparison of In-Hospital Versus Private Clinic Rehabilitation.

Purpose: To determine if rehabilitation after anterior cruciate ligament (ACL) reconstruction (ACL-R) in a tertiary care paediatric orthopaedic centre (TPOC) yields superior outcomes compared to private clinic (PC) rehabilitation. Method: In this retrospective analysis, patients aged 13 to 18 years who underwent standardized isokinetic knee assessment 5 to 7 months after ACL-R were reviewed. Exclusion criteria: previous injury to the non-operated limb, neuromuscular musculoskeletal disorder, isolated meniscal repair, isolated meniscectomy, posterior cruciate ligament reconstruction, and medial patellofemoral ligament reconstruction. To determine which of the two rehabilitation settings had the best outcomes, isokinetic parameters and patient-reported outcomes were compared between the TPOC and the PC groups using univariate analysis of variance.

Results

Among 276 patients (63% female), 34 performed rehabilitation in a PC (12%) and 242 performed their rehabilitation in a TPOC (88%). Except "ACL graft used" (p < 0.05), no significant difference was found in demographic variables between the two rehabilitation groups. Patients who attended the TPOC setting had significantly higher limb symmetry index in flexion at 180°/s (p = 0.04), average relative peak torque in extension at 60°/s (p = 0.03), z-score at 60°/s in extension (p = 0.03), and total work at 60°/s in flexion (p = 0.04) compared to the PC group. ACL Return to Sport after Injury Scale scores were superior for PC rehabilitation patients (mean 83 [SD 20]) compared to patients attending the TPOC (mean 70 [SD 18]) (p = 0.03).

Conclusions

Patients managed in a TPOC have better isokinetic outcomes 6 to 7 months post-surgery compared to patients managed in a PC rehabilitation setting, which may suggest that the expertise and multidisciplinary nature of the TPOC favour rehabilitation.