Exercise therapy plus education does wonders in persistent knee problems after ACLR

Patient-reported outcomes among young adults with persistent knee problems after anterior cruciate ligament reconstruction (ACLR) improve with physiotherapist-supervised exercise therapy plus education compared with a single education session and self-directed exercise resource, according to a study.

However, differences between groups may not be sustained over time, said the investigators, who conducted a parallel-group randomized trials in 184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR.

Of the participants, 92 were randomized to a 4-month twice-weekly supervised exercise therapy and patient education rehabilitation (SUPER) and 92 to a single physiotherapist-delivered education session and self-directed exercise resource (control).

Of the participants (mean age 30 years), 178 (97 percent) and 174 (95 percent) completed the 4-month and 12-month follow-up, respectively.

At 4 months, the Knee injury and Osteoarthritis Outcome Score (KOOS) improved more among patients in the SUPER vs control groups (14.1 vs 9.4; adjusted mean difference, 4.8, 95 percent confidence interval [CI], 1.4‒8.2). SUPER also resulted in greater muscle strength gains and higher rates of success on global rating of change (eg, pain: 73 percent vs 40 percent).

At 12 months, between-group differences diminished as the control group showed continued improvement, while gains associated with SUPER persisted. No between-group differences were noted in cartilage thickness or composition.

“Chronic knee symptoms and early-onset osteoarthritis are common after ACLR,” the investigators said. “Evidence to inform management is needed.”