Effects of accelerated rehabilitation after ACL reconstruction on clinical and functional outcomes: A systematic review and meta-analysis evaluating clinical meaningfulness.

Abstract

Purpose: Pain, joint laxity, deficits in functional performance and proprioception are common after anterior cruciate ligament reconstruction (ACLR). The role of accelerated rehabilitation (AR) in addressing these outcomes remains uncertain. This systematic review and meta-analysis aimed to evaluate the effects of AR on laxity, functional performance, proprioception and pain in individuals post-ACLR.

Method: Four databases (PubMed, Web of Science, Scopus, Embase) were searched until March 2026. Eligible interventional studies comparing AR with standard exercise in individuals post-ACLR were included. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Risk of bias was assessed using the PEDro and Newcastle-Ottawa scales. Knee pain and laxity were defined as the primary outcome, with functional performance and proprioception evaluated as secondary outcomes. Random-effects models calculated mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs).

Results: Ten studies (n = 2180 participants) were included. AR resulted in statistically significant improvements in knee laxity (MD: -0.50; 95% CI: -0.65 to -0.36; p < 0.001), proprioception (SMD: 0.20; 95% CI: 0.10-0.30; p < 0.001) and performance outcomes, such as single-leg hop (SMD: 0.85; 95% CI: 0.43-1.27; p < 0.001), International Knee Documentation Committee (MD: 2.39; 95% CI: 0.74-4.03; p = 0.004) and Lysholm score (MD: 1.54; 95% CI: 0.01-3.07; p = 0.04). However, these changes did not reach established thresholds for clinical meaningfulness, and the knee pain outcome (SMD: -0.14, 95% CI: -0.54 to 0.24, p = 0.45) showed no significant changes.

Conclusion: AR was associated with statistically detectable changes in knee laxity, functional outcomes and knee proprioception; however, these effects had limited clinical relevance and did not extend to pain reduction. Therefore, the clinical value of AR in optimizing post-ACLR recovery remains uncertain.

Level of evidence: Level I.