A comparison between physical therapy clinics with high and low rehabilitative volumes in patients with ACL reconstruction

Abstract

AbstractBackground Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy clinics in terms of odds for a second ACL injury, return to pre-injury level of sports, perceived knee function, and recovery of strength and hop performance. Method Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. Result Of the 115 rehabilitation clinics included, 111were classified as low-volume clinics, and 4 as high-volume clinics. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first year and 68 (4.0%) within two years. No difference in the incidence of a second ACL injury, within 1 year follow-up OR 0.95 [95% CI 0.46–1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68–1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in PROs and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury sports. Conclusion No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapy clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury sports.