Via a scoping review, we evaluated the clinical reproducibility of rehabilitation programs in published peer-reviewed articles describing primary ACL-R.
We performed a systematic literature search, on 8 July 2024, using the following medical databases: MEDLINE via PubMed, Web of Science, Cochrane Library, and Scopus. Following title, abstract, and full-text screening, 250 studies including 29,216 individuals were identified that satisfied our pre-specified inclusion criteria. Before data extraction, 2 authors (SN, ED) developed the preliminary domains to categorize the descriptions of the post-operative rehabilitation programs. One author (SN) adapted these domains based on the emerging characteristics of the extracted data observed during the data charting process. Additionally, the post-operative rehabilitation programs described in each study were evaluated using the template for intervention description and replication (TIDieR) checklist (12 items) to determine their clinical reproducibility; a score of 0 (minimum) to 12 (maximum) was assigned to each study. A median TIDier score was determined for each domain used to categorize the descriptions of the rehabilitation programs. The following scores were assigned to classify the clinical reproducibility of the post-operative rehabilitation programs: TIDier score 0-4 = not clear; 5-8 = somewhat clear; 9-12 = clear.
At the end of the data charting process, 27 domains were included to categorize the descriptions of the post-operative rehabilitation programs. ACL-R via arthroscopy was the most performed surgical procedure (79%) and bone-patellar-tendon-bone graft the most frequently used graft type (45%). Concurrent lesions to ACL rupture were reported in 31% of the studies; meniscus lesions were the most common concomitant injury (61%). Almost half of the studies did not report the presence/absence of any concomitant intra-articular injuries. Across the included studies, there was a substantial degree of heterogeneity in the thoroughness of reporting of ACL-R rehabilitation programs. The highest number of domains described in any study was 20, but only one study (0.4%) achieved this level of reporting. Forty studies (16%) only included 1 domain when describing their ACL-R rehabilitation program. An average of 75% of studies per domain reported whether the decision-making on interventions was time- or criteria-based, with 89.5% being the first. The domain’s reproducibility in clinical practice, rated with the median of the TIDieRs of all the studies concurring to each domain, resulted unclear (mcTIDieR min-max score = 6.24-7.23/12). Studies often lacked proper detail on the delivered post-operative PT interventions and/or progression parameters.
Post-primary ACL-R rehabilitation programs in published peer-reviewed articles are largely clinically reproducible.
This study's findings can lead clinicians to carefully evaluate the published literature describing rehabilitation programs for patients after ACL-R.
rehabilitation
physical therapy
