Internet-based digital interventions on rehabilitation for patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.

backgroundAnterior cruciate ligament reconstruction (ACLR) is the primary method for treating Anterior cruciate ligament injuries. Internet-based digital interventions offer a scientifically standardized rehabilitation model, enhancing patient adherence to rehabilitation and promoting knee joint function recovery. However, there is a lack of comprehensive evaluation in this area. Therefore, this study aims to compile relevant literature on the application of internet-based digital interventions in rehabilitation following ACLR, with the goal of clarifying their intervention effects and providing insights for promoting the use of digital rehabilitation in patients undergoing ACLR.

objectiveThis review aimed to examine the effectiveness of internet-based digital interventions for the rehabilitation of patients who have undergone ACLR.

methodsThis review employed a systematic review and meta-analysis as the research design. A comprehensive search of seven databases, including PubMed, Embase, the Cochrane Library, Scopus, MEDLINE, CINAHL and SinoMed, was conducted up to November 2024. To identify randomized controlled trials (RCTs) on postoperative rehabilitation for ACLR patients using internet-based methods such as mobile apps and websites. Two reviewers worked independently to identify RCTs and extract data. This study will evaluate the outcomes using primary endpoints (rehabilitation exercise adherence, range of motion, Lysholm Knee Score, and International Knee Documentation Committee score) and secondary endpoints (pain, thigh circumference difference, muscle strength, cost, and satisfaction). The study includes research utilizing various outcome measures, with results presented using standardized mean differences (SMD) and 95% confidence intervals (CI). The quality of the included RCTs was evaluated via the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions.

resultsThis review included 14 studies encompassing 1,019 patients who underwent ACLR. The meta-analysis demonstrated that, compared with the control interventions, internet-based digital interventions significantly improved range of motion (SMD = 1.47, 95%CI [0.08, 2.87], p = 0.04) and rehabilitation exercise adherence (SMD = 0.37, 95% CI [0.14, 0.61], p = 0.001) at 6–12 weeks of intervention. With respect to knee joint function, significant improvements were observed at both < 6 weeks (SMD = 1.01, 95% CI [0.23, 1.79], p = 0.01) and 6–12 weeks (SMD = 0.66, 95% CI [0.02, 1.30], p = 0.04]. Furthermore, narrative analysis suggested that internet-based digital interventions had additional positive effects on pain relief, patient satisfaction, muscle strength, and healthcare costs in ACLR patients.

conclusionsInternet-based digital interventions can facilitate the recovery of knee joint function in patients after anterior cruciate ligament reconstruction. During the intervention period of 6 to 12 weeks, they significantly improve rehabilitation exercise adherence and range of motion. However, when the intervention duration is less than 6 weeks, the differences are not statistically significant. Nonetheless, there are potential benefits in outcomes such as pain reduction, muscle strength improvement, and lower healthcare costs. High-quality evidence is needed in the future to support the conclusions of this study.

trial registrationThis review was registered in the Prospective Register of Systematic Reviews (PROSPERO, ID: CRD42024621049).