Rehabilitation after anterior cruciate ligament reconstruction. Inpatient or outpatient rehabilitation: a series of 103 patients

Purpose of the study The goal of this work was to evaluate outpatient rehab ilitation after anterior curciate ligament reconstruction using the bone-te ndon technique. Material and methods This was a prospective non-randomized study of 103 con secutive patients participating in the same rehabilitation program, excepti ng for the first month. During the first postoperative month, 55 patients ( group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpat ient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment ( mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and t o renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months posto peratively. Results There was no statistical difference for the pre and peroperative da ta between the two groups, with the exception of meniscal tears that were m ore frequent in group A (p < 0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater f lexion at 3 weeks in group B (related to difference in measurement date). F ifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (inclu ding one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of pers istent femoropatellar syndromes, one of which occurred after reflex dystrop hy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered w hen interpreting the results. Discussion This is the first report comparing inpatient and outpatient reha bilitation protocols after anterior cruciate ligament reconstruction. The o nly reports in the literature have compared different ambulatory rehabilita tion programs that appear to be internationally accepted as the routine pro cedure. The current trend towards short hospital stays for surgery is compa tible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for a nterior cruciate ligament reconstruction is compatible with an outpatient r ehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those ob tained after inpatient programs conducted in a rehabilitation facility duri ng the first postoperative month.