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

Purpose: To identify whether the 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 patients aged 18 to 64 years who initiated supervised physical rehabilitation at 0 to 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; P < .05 was considered statistically significant.

Results: The cohort included 13,273 patients (33.7% of whom 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 timing (0-3 days) and latest timing (15-30 days) of initiating supervised rehabilitation and 12-month arthrofibrosis diagnosis (odds ratio, 1.15; 95% confidence interval, 0.97-1.36; P = .10) or surgical intervention (odds ratio, 0.81; 95% confidence interval, 0.53-1.22; P = .31). There were also no significant adjusted associations between any other timing of initiating supervised rehabilitation (compared with 15-30 days) and arthrofibrosis diagnosis or surgical intervention (P > .05 for all).

Conclusions: Approximately 1 in 10 patients undergoing isolated arthroscopic ACLR and initiating supervised rehabilitation within 30 days after surgery received a diagnosis of 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 after surgery was not significantly associated with the incidence of 12-month arthrofibrosis diagnosis or surgical intervention.

Level of evidence: Level III, therapeutic, retrospective comparative study.