Earlier Initiation of Supervised Physical Rehabilitation Is Not Associated with Decreased Arthrofibrosis After Isolated Arthroscopic Anterior Cruciate Ligament Reconstruction

Ashley M Rosenberg; Brocha Z Stern; Justin Tiao; Timothy Hoang; Bashar Zaidat; Christon N Darden; James N Gladstone; Shawn G Anthony

doi:10.1016/j.arthro.2024.12.004

Earlier Initiation of Supervised Physical Rehabilitation Is Not Associated with Decreased Arthrofibrosis After Isolated Arthroscopic Anterior Cruciate Ligament Reconstruction

Arthroscopy. 2024 Dec 11:S0749-8063(24)01030-2. doi: 10.1016/j.arthro.2024.12.004. Online ahead of print.

Authors

Ashley M Rosenberg¹, Brocha Z Stern², Justin Tiao¹, Timothy Hoang¹, Bashar Zaidat¹, Christon N Darden¹, James N Gladstone¹, Shawn G Anthony³

Affiliations

¹ Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: shawn.anthony@mountsinai.org.

PMID: 39672248
DOI: 10.1016/j.arthro.2024.12.004

Abstract

Purpose: To identify if timing of supervised physical rehabilitation initiation after isolated arthroscopic anterior cruciate ligament reconstruction (ACLR) is associated with 1) diagnosis of arthrofibrosis and 2) surgical intervention for arthrofibrosis within 12 months after surgery.

Methods: Outpatient isolated arthroscopic ACLR procedures in 2017-2020 were identified from the Merative MarketScan Database. The cohort was limited to those aged 18-64 who initiated supervised physical rehabilitation 0-30 days postoperatively and had continuous enrollment in the database for 12 months before and after surgery. Multivariable logistic regression models analyzed the adjusted relationship between rehabilitation initiation timing (categorized as 0-3, 4-7, 8-14, and 15-30 days) and arthrofibrosis outcomes; statistically significant p-values were <0.05.

Results: The cohort included 13,273 patients (33.7% initiated rehabilitation 0-3 days after surgery, 27.1% 4-7 days, 22.5% 8-14 days, and 16.7% 15-30 days). The incidence of 12-month arthrofibrosis diagnosis was 11.6%, and the incidence of 12-month surgical intervention for arthrofibrosis was 1.6%. There were no significant adjusted associations between the earliest (0-3 days) versus latest (15-30 days) timing of initiating supervised rehabilitation and 12-month arthrofibrosis diagnosis (OR 1.15, 95% CI 0.97-1.36, P=0.10) or surgical intervention (OR 0.81, 95% CI 0.53-1.22, P=0.31). There were also no significant adjusted associations between any other timing of initiating supervised rehabilitation (compared to 15-30 days) and arthrofibrosis diagnosis or surgical intervention (all P>0.05).

Conclusion: Approximately 1 in 10 patients undergoing isolated arthroscopic ACLR and initiating supervised rehabilitation within 30 days after surgery was diagnosed with arthrofibrosis within 12 months, indicating that this complication is quite common. The number of patients receiving surgical intervention for arthrofibrosis was much lower. Timing of supervised physical rehabilitation initiation within the first 30 days post surgery was not significantly associated with incidence of 12-month arthrofibrosis diagnosis or surgical intervention.

Level of evidence: Level III (Therapeutic: Retrospective Comparative Study).