Abstract
Objectives:
To identify if timing of supervised physical rehabilitation initiation after arthroscopic ACLR is associated with 1) diagnosis of arthrofibrosis and 2) surgical intervention for arthrofibrosis within 12 months after surgery.
Methods:
Patients aged 18 to 64 in the United States who underwent outpatient ACLR between January 1, 2017 and December 31, 2020 and initiated supervised physical rehabilitation 0-30 days postoperatively were identified using the Merative MarketScan Commercial Claims and Encounters Database. Multivariable logistic regression models analyzed the adjusted relationship between rehabilitation initiation timing (categorized as 0-3, 4-7, 8-14, and 15-30 days) and arthrofibrosis outcomes; statistically significant p-values were < 0.05.
Results:
The cohort included 13,273 patients (33.7% initiated rehabilitation 0-3 days after surgery, 27.1% 4-7 days, 22.5% 8-14 days, and 16.7% 15-30 days). The incidence of 12-month arthrofibrosis diagnosis was 11.6% and 1.6% for surgical intervention. There were no significant adjusted associations between timing of initiating rehabilitation and arthrofibrosis diagnosis (OR 1.04-1.11, p=0.17-.60) or surgical intervention (OR 0.74-0.91, p=0.13-0.61).
Conclusions:
Approximately 1 in 10 ACLR patients initiating rehabilitation within 30 days after surgery was diagnosed with arthrofibrosis within 12 months, indicating that this complication is quite common. The number of patients receiving surgical intervention for arthrofibrosis was much lower. Timing of supervised physical rehabilitation initiation within the first 30 days post surgery was not significantly associated with 12-month arthrofibrosis diagnosis or surgical intervention. The findings in this study suggest that encouraging initiation of physical rehabilitation very early in the postoperative window, which can pose many difficulties for patients both in terms of pain and accessibility, may not be necessary for avoidance of arthrofibrosis. Further examination is warranted to identify at-risk patients and provide personalized ACL rehabilitation programs to prevent development of arthrofibrosis.
