Influence of Demographic & PT Interventions on Outcomes & Revision Rates Following ACL Reconstruction.

Recent evolutions in healthcare delivery are putting physical therapists in the forefront to be more responsible for providing high-quality rehabilitation care within a more cost-effective manner. Studies investigating the association between physical therapy (PT) visit utilization and outcomes in vulnerable patient populations following anterior cruciate ligament reconstruction (ACLR) may provide useful insights.

The aim of this study was to examine the relationship between patient age, gender, PT visit utilization and PT intervention charges on revision rates and patient-reported outcomes in individuals following primary ACLR. This was achieved through a following 660 patients post ACLR. Age and PT visit utilization were categorized to examine effects between groups (age: ≤20, 21-34, ≥35; visits: <9, 9-14, >15). Multilevel mixed effects linear models were conducted to compare differences between revision rates and patient-reported outcomes during the episode of care. Receiver Operating Characteristic curve analyses were also used to determine visit number and charge per visit cut-points to discriminate patients who achieved at least a minimal clinically important difference on the patient-reported outcomes.

Twenty two of 660 (3.4%) of the cohort had revision surgery. Compared with patients 20 and younger, the incidence rate ratio of ACLR revisions was lower in patients that were 35 years and older (85%) and 21-34 years (59%). Of 470 patients who attended PT >3 months, change in KOS-ADL score was significantly lower among patients younger than 20 years and in the lowest visit category.

Achievement of favorable outcomes following ACLR may require categorization of patients beyond surgical diagnosis alone. Younger patients (≤20) attending fewer PT visits (<9) were more likely to have ACL revision surgery and had inferior patient-reported outcomes compared to older and higher PT visit utilization counterparts. The retrospective cohort design limits causative relationships from being concluded. Additionally, this study was conducted in only one geographic region within a single healthcare delivery system, which may limit the generalizability of the results.