Comparison of Two Different Rehabilitation Approaches Applied Following Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

INTRODUCTION: This study was to investigate and analyze the effects on pain, range of motion (ROM), functional status, balance, quality of life (QOL), and kinesiophobia between a rehabilitation program including traditional physiotherapy and dual-task exercises (CP + DT) and another rehabilitation program including foam roller application in addition to traditional physiotherapy and dual-task exercises (CP+DT+FR) in patients undergoing anterior cruciate ligament reconstruction (ACL-R).
METHODS: A total of 28 patients who underwent unilateral arthroscopic anterior cruciate ligament (ACL) reconstruction using hamstring tendon graft were included in this randomized controlled study. Patients who underwent ACL reconstruction for the 1st time, were in the post-operative rehabilitation phase, and were still participating in the study up to 1 year, were eligible for inclusion. Individuals with bilateral ACL injury, concomitant ligament injuries, previous knee surgery, or neurologic disorders affecting balance were excluded. Participants were divided into two groups using the randomization method, which was created by randomly drawing the group names we wrote on the papers according to their order of arrival: Traditional physiotherapy plus dual-tasking exercise group (CP+DT; n=14; mean age: 27.64 ± 6.51 years; 14 males) and traditional physiotherapy, dual-tasking and foam roller exercise group (CP+DT+FR; n=14; mean age: 23.07±3.97 years; 11 males and 3 females). All participants attended supervised rehabilitation sessions 3 times a week for a total of 8 weeks. Outcome measures were assessed at baseline and at the end of the 8-week intervention period and included measures of pain intensity, knee ROM, functional status, balance performance, QOL, and kinesiophobia.
RESULTS: Both rehabilitation groups demonstrated statistically significant improvements in pain intensity, knee ROM, functional status, balance performance, QOL, and kinesiophobia from baseline to the end of the 8-week intervention period (p < 0.05). However, when between-group comparisons were performed, no statistically significant differences were observed between the CP+DT and CP+DT+FR groups for any of the outcome measures (p>0.05). These findings indicate that while both rehabilitation protocols were effective in improving clinical and functional outcomes following ACL reconstruction, the addition of foam roller exercises did not confer a statistically superior benefit compared with conventional physiotherapy combined with dual-task training.
DISCUSSION AND CONCLUSION: The findings of the present study indicate that an 8-week intervention comprising conventional physiotherapy and dual-task exercises leads to significant improvements in clinical outcomes. Nevertheless, incorporating foam roller exercises into this rehabilitation protocol does not provide additional advantages with respect to pain, ROM, functionality, balance, QOL, or kinesiophobia. These results suggest that the inclusion of foam roller exercises does not appear to enhance clinical outcomes beyond those achieved with conventional physiotherapy and dual-task training within the study period.

Keywords: Anterior cruciate ligament reconstruction, exercise, outcomes, rehabilitation.