More PT Utilization Correlates with Higher Rate of Second ACL Reconstruction

    Age, gender, and frequency of physical therapy (PT) utilization after anterior cruciate ligament (ACL) surgery may be correlated with rates of second ACL reconstructions, according to research presented at the American Orthopaedic Society for Sports Medicine’s Specialty Day today.

    “Participation in physical therapy correlates with higher second ACL tear rates within both 12 and 24 months, especially in young females,” said lead researcher, Jonathan Godin, MD, MBA of Duke University Medical Center in Durham, NC.

    “PT is of particular value in young athletes who are at a high risk of a future injury. However, our research noted that patients [who] heavily utilize PT after ACL reconstruction – more than 30 visits in a 6-month period – are in fact at the highest risk of a second ACL injury, as high as 25%.”

    The authors emphasized that this is a correlation, not necessarily a causative relationship.

    Dr. Godin and his colleagues analyzed the records of 13,089 patients who had undergone ACL reconstruction between 2007 and 2014 using the PearlDiver database. Demographic data, including age and sex, were also analyzed as part of the study.

    PT use was determined by the percentage of patients with postoperative physical therapy codes at 2, 4, 6, 12, and 24 weeks after surgery. Patients who had additional ACL reconstructions within 24 months were also identified.

    A total of 513 patients had a second ACL surgery. Women had a slightly higher rate of subsequent ACL surgery than men, 7.0% vs 6.0% respectively.

    “This is the first analysis of a large database to report PT utilization rates following ACL reconstruction and the effects it has on subsequent ACL tears,” Dr. Godin said.

    “However, the reason for a correlation between heavy PT utilization and secondary ACL injury remains unknown. Potential explanations include increased PT utilization in patients that return to high-risk sports, or potentially increased utilization in patients with poor neuromuscular skills that aren’t easily corrected in therapy.

    “Regardless, this provides a simple strategy for identifying patients at the highest risk of subsequent injury for prevention research.”

    In the study, Dr. Godin and his colleagues noted that PT provides value in patients who have undergone ACL reconstruction. Patients who participated in PT had about a 3-fold lower incidence of ipsilateral or contralateral ACL reconstruction: 3.9% for those who participated in PT versus 10.6% for those who did not. In addition, the cost for PT was less than 10% of the total cost of the procedure, at $1,879 per patient.

    But the right number of PT visits is still to be determined, they said.

    “We also hope to be able to investigate what the ‘sweet spot’ is for appropriate PT visits after ACL reconstruction,” Dr. Godin said, “as increased utilization, and cost, don’t clearly correlate with improved outcomes.”


    Godin J, Dekker TJ, Garrett WE, Riboh JC. Risk factors for revision or contralateral ACL reconstruction: the value of physical therapy. Presented at the American Orthopaedic Society for Sports Medicine’s Specialty Day, March 18, 2017, in San Diego, California.