The relationship between the quantity and duration of post-operative physiotherapy treatment and patient outcomes following primary anterior cruciate ligament reconstruction: a systematic review

Abstract Background Functional rehabilitation following anterior cruciate ligament reconstruction (ACLR) is often physiotherapist-led, and generally required to achieve patient goals. The quantity and duration of physiotherapist-led following could therefore potentially influence outcomes following ACLR, although the nature of this relationship is not clear. Objective To clarify the relationship between the quantity and duration of post-operative physiotherapy treatment and patient outcomes following ACLR. Methods A search of the PubMed/MEDLINE, Google Scholar, Cochrane Library, and EBSCO databases was made from inception to March 2021 to identify relevant studies. Key characteristics of the selected studies were extracted, with methodological quality evaluated using a modified version of the Downs and Black appraisal tool. Results The search strategy identified 1137 studies, 15 of which met inclusion criteria. Two studies were rated strong methodological quality, eight were rated moderate, and five were rated limited. Results across all 15 studies provided conflicting evidence regarding the effects of the quantity and duration of physiotherapy treatment on patient outcomes following ACLR. Conclusions Based on evidence of variable methodological quality, a clear relationship between the quantity and duration of physiotherapy treatment and patient outcomes following ACLR could not be established. Several themes were identified to guide future research in this area, including ensuring participant homogeneity, monitoring participant adherence to unsupervised rehabilitation, and utilising rehabilitation interventions that replicate everyday physiotherapy practice.