Accelerated Versus Non-accelerated Rehabilitation After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Systematic Review and Meta-analysis of Comparative Studies

Purpose: This study aimed to compare the clinical outcomes between accelerated rehabilitation (AR) and non-accelerated rehabilitation (NR) after anterior cruciate ligament reconstruction (ACLR) using hamstring autografts through a systematic review and meta-analysis. Methods: To compare the outcomes between AR and NR, we searched Medline, Embase, and the Cochrane Library. Studies comparing their clinical outcomes after ACLR using hamstring autografts were included. AR was characterized by the starting range of motion and weight-bearing within 3 days and return to sports within 6–9 months. A meta-analysis of clinical outcome parameters used in ≥ 3 studies was conducted. Results: Seven studies were included. The International Knee Documentation Committee subjective score was significantly higher in AR than in NR at the 3- (mean difference [MD], 7.30; 95% confidence interval [CI] 1.55–13.05; P = 0.013) and 6-month follow-ups (MD, 5.64; 95% CI 0.11–11.17; P = 0.046). The side-to-side difference in anterior tibial translation at the final follow-up assessed in four studies was significantly lower in NR than in AR (MD, 0.59; 95% CI 0.12–1.07; P = 0.015). Overall Tunnel widening at the final follow-up assessed in four studies was also smaller in NR than in AR (MD, 0.48; 95% CI 0.00–0.96; P = 0.0479). However, the mean side-to-side difference and overall tunnel widening between them was < 1 mm. Conclusion: The early subjective clinical outcomes of AR after ACLR using hamstring autografts were superior to those of NR. Although tunnel widening and anterior instability were also significantly larger in AR than in NR, the difference was not clinically relevant.