Limited Use of Supervised Physical Rehabilitation Beyond 3 Months After Arthroscopic Anterior Cruciate Ligament Reconstruction With Greater Use in Female and Younger Patients.

Purpose: To characterize the initiation and use of supervised physical rehabilitation after arthroscopic anterior cruciate ligament reconstruction (ACLR), including overall duration of rehabilitation and number of rehabilitation visits, and to describe demographic and clinical predictors of rehabilitation initiation and use characteristics.

Methods: Patients aged 14 to 64 years in the United States who underwent ACLR from 2017 to 2020 were identified using the Merative MarketScan Database. For patients initiating rehabilitation within 45 days postoperatively, the overall duration and number of visits within 1 year after surgery were determined. Visits were categorized into rehabilitation phases, with visits 0-90 days postoperatively categorized as phase I, 91-180 days as phase II, 181-270 days as phase III, and 271-365 days as phase IV. Multivariable regression models identified predictors of rehabilitation initiation, duration in days, and number of visits.

Results: Of 20,097 patients who underwent ACLR, 88.1% (n = 17,704) initiated postoperative rehabilitation, receiving phase I services. Additionally, 55.0% (n = 11,053) received phase II services, 17.0% (n = 3417) phase III services, and 3.9% (n = 779) phase IV services. The median duration was 104 days (interquartile range 63-157), and the median number of visits was 21 (interquartile range 12-32). Multiple significant predictors of rehabilitation initiation, duration, and number of visits were found.

Conclusions: Although most patients use supervised physical rehabilitation after ACLR, only 55% receive rehabilitation beyond 3 months and only 17% beyond 6 months after surgery. There are several significant drivers of rehabilitation initiation, overall duration, and number of visits. Female and younger patients have greater use of rehabilitation, and notable regional differences suggest an opportunity to improve standardization of care.

Level Of Evidence: Level III, retrospective descriptive study.