Exercise Therapy and Education for Young Adults With Persistent Knee Problems After Anterior Cruciate Ligament Reconstruction : A Randomized Clinical Trial
In brief
Supervised rehab lifts knee scores 4.8 points after ACL reconstruction
In a randomized trial of 184 young adults with ongoing knee problems after ACL reconstruction, four months of supervised exercise and education improved knee scores more than one education session and self-directed exercise: a 4.8-point greater gain. More participants reported pain improvement, but group differences narrowed by 12 months and MRI showed no cartilage changes between groups.
- Journal
- Annals of internal medicine (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Adam G Culvenor, Andrea M Bruder, Thomas J West, Christian J Barton, Ewa M Roos, Edwin H Oei, et al.
- PMID
- 42804769
- DOI
- 10.7326/ANNALS-26-02460
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 18 October 2026): Supervised rehab improves KOOS after ACL reconstruction
Abstract
BACKGROUND: Chronic knee symptoms and early-onset osteoarthritis are common after anterior cruciate ligament reconstruction (ACLR). Evidence to inform management is needed. OBJECTIVE: To evaluate whether physiotherapist-supervised exercise therapy with education is superior to a single education session and self-directed exercise resource for young adults with persistent knee problems after ACLR. DESIGN: Parallel-group randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620001164987). SETTING: Community. PARTICIPANTS: 184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR. INTERVENTION: A 4-month twice-weekly physiotherapist-supervised exercise therapy program with education (SUPER [SUpervised exercise-therapy and Patient Education Rehabilitation]; n = 92) and a single physiotherapist-delivered education session and self-directed exercise resource (control; n = 92). MEASUREMENTS: Primary outcome was 4-month change in the composite Knee injury and Osteoarthritis Outcome Score (KOOS4; 0= worst, 100= best). Secondary outcomes included KOOS4 at 12 months and thigh muscle strength, patient-perceived global rating of change, and cartilage thickness and composition on magnetic resonance imaging at 4 and 12 months. RESULTS: 184 participants were randomly assigned (mean age, 30 years [SD, 6]; 2.2 years [SD, 0.7] after ACLR); 178 (97%) and 174 (95%) completed 4-month and 12-month follow-up, respectively. At 4 months, KOOS4 scores improved more in the SUPER group than in the control group (14.1 vs. 9.4; adjusted mean difference, 4.8 [95% CI, 1.4 to 8.2]). At 4 months, SUPER resulted in greater muscle strength gains and higher rates of success on global rating of change (for example, pain 73% vs. 40%). Between-group differences narrowed at 12 months as the control group continued to improve, whereas SUPER gains were sustained. There were no between-group differences seen in cartilage thickness or composition. LIMITATION: Unblinded participants. CONCLUSION: For young adults with persistent knee problems after ACLR, physiotherapist-supervised exercise therapy with education improved patient-reported outcomes compared with a single education session and self-directed exercise resource, but these between-group differences may not be sustained over time. PRIMARY FUNDING SOURCE: National Health and Medical Research Council.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.