Effectiveness of a supervised rehabilitation compared with a home- based rehabilitation following anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Objective: This systematic review aimed to compare the effectiveness of supervised rehabilitation with regard to knee function with that of home-based rehabilitation in patients undergoing anterior cruciate ligament reconstruction (ACLR). Methods: The databases searched were: the Cochrane Central Register of Controlled Trials (Central), EMBASE, MEDLINE (via Ovid) and PEDro. All randomized controlled trials comparing supervised rehabilitation (SVR) with home-based rehabilitation (HBR) following ACLR were included. Two reviewers evaluated the study quality using the Cochrane Risk of Bias Assessment (RoB 2.0) tool. Estimates are presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: A total of nine studies met the inclusion criteria, and five studies were included in the meta analysis. The key outcomes analyzed were self-reported knee function and knee muscle strength. Across all comparisons, there was very low-quality evidence of no significant difference between the SVR and HBR groups at 24 weeks. Conclusions: The limited evidence available does not suggest that SVR results in superior outcomes than HBR in patients with ACLR. Additional studies are needed to clarify whether patient characteristics and study protocols with longer interventions effect the results.