Outcomes Of Self Instructed Home-Based Versus Hospital Supervised Rehabilitation Following Arthroscopic Anterior Cruciate Ligament Reconstruction At Muhimbili Orthopedic Institute

Abstract

Rehabilitation after arthroscopically reconstructed Anterior cruciate ligament is recommended for a better outcome and return to patients’ daily and sports activities within a short period. The surgical reconstruction aims to restore the anatomy and normal functioning of the knee joint. Rehabilitation improves knee range of motion, muscular strength and gait to the optimum. Objective The purpose of this study was to compare the outcomes between patients receiving initial self-instructed home-based rehabilitation versus hospital-supervised rehabilitation following arthroscopic ACL reconstruction at MOI The null hypothesis formulated that “There is no difference in functional outcomes between initial self-instructed home-based and Hospital supervised rehabilitation programs after arthroscopic ACL reconstruction at MOI”. Materials and Methodology The study design was a prospective observational cohort study involving participants with anterior cruciate ligament tear treated by arthroscopic ACL reconstruction using hamstring tendon autografts. The study was conducted at MOI for the period of six months from July 2020 to December 2020. A total of 50 participants were obtained through convenient sampling. They were assigned to either Hospital supervised rehabilitation or self-instructed home-based rehabilitation as preferred by their surgeon. Participant’s age, sex, site of the affected knee, knee range of motion, thigh muscle atrophy, quadriceps muscle strength grading. The patient’s performance of the activity of daily living was assessed using the Lysholm knee score scale pre-operatively, and at the second, fourth and twelfth week. The angle of knee flexion was assessed before ACL reconstruction and at the fourth and twelfth week by using a goniometer. Immediately after ACL, reconstruction patients in both groups started on supervised physiotherapy protocol until the day of discharge. The Hospital Supervised rehabilitation xiv group proceeded at the hospital under the supervision and self-instructed home-based group instructed to continue with self-exercise program at home. One month later both groups came to the outpatient clinics for the quadriceps muscle strengthening and knee range of motion program. Data was collected, analyzed and reported by the principal investigator Results Out of 50 participants, three were lost to follow-up and analysis was done for 47 patients. The Hospital Supervised rehabilitation group had 23(49%) participants and the self instructed home-based group was 24 (51%). The number of the male was 36 (76.6%) and female 11 (23.4%) with the male to female ratio 3.3:1. The majority of the Participants were below 40 years 40 (85.1%) with a total mean age of 32.15+ 8.71 SD. The study found 42 (89.4%) participants had their ACL reconstruction done more than three months post-injury and below three months 5. The main cause of ACL tear was sports-related activities 40 and road traffic crush 7. Two participants (4.3%) were observed to have grade one knee laxity from the hospital supervised group. However, there was no significant statistical association of knee laxity between groups (P-value 0.234). All participants had normal muscle strength in both rehabilitation groups. Muscle atrophy was observed in two participants in home-based rehabilitation and one in the hospital-supervised group (P-value 1). Two participants got superficial surgical site infection in the home-based rehabilitation group. There was an association of surgical site infection but not significant (P-value 0.489). A consecutive assessment revealed a significant improvement in knee flexion over time in both groups however hospital supervised rehabilitation group had more compared to home based rehabilitation at the first and third-month post ACL reconstruction. The hospital supervised group demonstrated mean knee flexion at one month and three months after xv ACL reconstruction 103.040 +5.790 and 125.20 + 5.140 compared to the Home-based group 95.80 +5.740 and 115.30 + 5.740 respectively. The performance of daily life activity revealed a significant improvement in mean Lysholm score over time in both groups but no significant statistical difference between the rehabilitation groups regardless of initial disparity. The mean Lysholm score for the Home-based rehabilitation (before ACL reconstruction 52+5.6, second week 66+4.9, fourth week 78.5+4.2, twelfth week 88.3+3.4) and the hospital-supervised rehabilitation (before ACL reconstruction 49.4+7.4, second week 64.3+8.2, fourth week 79.9+7.4, twelfth-week 92.9.9+2.9). Conclusion The finding was that the hospital supervised rehabilitation group revealed a greater knee range of flexion during the first and third months compared to self-instructed home-based rehabilitation. There were no significant statistical differences between the two rehabilitation groups in the anterior knee laxity, quadriceps muscle strength grading and thigh muscle atrophy and post-reconstruction superficial surgical site infection. A consecutive assessment of the performance of daily life activity revealed a significant improvement in mean Lysholm score over time in both groups but no significant difference between groups at a given period of assessment Recommendations Hospital supervised and home-based rehabilitation programs can be used in rehabilitating patients after Anterior cruciate ligament arthroscopic reconstruction as both lead to an equally better outcome and return to patients’ daily and sports activities within a short period. Further prospective studies which involve randomization with large sample size, longer follow-up period are recommended.