Physiotherapists instructed participants to perform home-based exercises including isometric quadriceps contractions and knee flexions during the first two weeks. Patients received information about the movements to be avoided (e.g. The content of the outpatient physiotherapy sessions was left at the discretion of the physiotherapist. At discharge, patients were referred to an outpatient physiotherapist for 2 to 3 sessions a week. Water-based exercise therapy was allowed after complete skin healing. To this end, patients had four 45-min sessions of physiotherapy per week including passive knee mobilisation, closed chain muscular stabilization exercises and proprioception exercises in bipodal then unipodal support, on stable then unstable planes. In the next 3 weeks, they aim to achieve 120° of flexion and a painfree knee without effusion. Briefly, in the first 3 weeks of the program, patients aim to achieve active locking in extension and 60–90° flexion of the knee. The outpatient program was conducted for 6 weeks at the rehabilitation center by experienced physiotherapists in accordance with the 2008 French Haute Autorité de Santé recommendations. Non-inclusion criteria were associated posterior cruciate ligament or medial collateral ligament injuries and insufficient proficiency in French. Inclusion criteria were age greater than 15 years, time elapsed between knee surgery and participation in the rehabilitation program less than 8 days, ACL rupture, either isolated or with meniscal involvement. Operated people fulfilling inclusion criteria and participating in the outpatient post-operative rehabilitation program at the rehabilitation center of Villiers-sur-Marne (France), from May 2018 to August 2019, were consecutively included. Our study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (Additional file 1). We conducted an exploratory observational retrospective single-centered study. In the present study, we aimed to describe characteristics of people with scores ≥ 60/100 and < 60/100 at 6 months after surgery and to identify variables independently associated with an ACL RSI < 60/100 score at 6 months. However, determinants of an ACL-RSI score ≥ 60/100 at 6 months after injury have been scarcely explored. Therefore, ACL-RSI score at 6 months after injury could be considered as an interim outcome of returning to sport in the long term after ACL injury. An ACL-RSI score ≥ 60/100 at 6 months after injury correlates with a higher rate of returning to sport at 2 years after injury. The ACL-Return to Sport after Injury (RSI) is a self-administered questionnaire, validated in 2008, specifically designed to quantify the apprehension to return to sport after ACL injury (0 = maximal apprehension and 100 = no apprehension). This rate can reach 83% in elite athletes. Approximately 65% of people return to a level of sport equivalent to that before 2 years post-operatively. Its surgical management has increased over the last decade. Rupture of the anterior cruciate ligament (ACL) is the most frequent knee ligament injury. Preoperative rehabilitation was independently associated with low apprehension at 6 months. In the multivariate analysis, preoperative rehabilitation was associated with low apprehension at 6 months (OR = 0.107, p = 0.002). Participants who had an ACL-RSI score ≥ 60/100 more often received a preoperative rehabilitation (16/21 vs 5/16 ), and had less often knee pain (7/21 vs 7/16 ) and effusion (5/21 vs 8/16 ) at 1 month after surgery, than participants who had an ACL-RSI score < 60/100. We included 37 participants: 13/37 (35.1%) were women and mean age was 27.2 (9.2) years. Multiple logistic regression was performed to identify baseline variables associated with low apprehension at 6 months. Baseline characteristics of people with ACL-RSI scores ≥ 60/100 and < 60/100 were described. The ACL-RSI questionnaire was self-administered at 6 months after injury. People who had surgery for an ACL rupture and who participated in an outpatient post-operative rehabilitation program were included consecutively. We conducted a single-center retrospective study. We aimed to describe characteristics of people with ACL-Return to Sport after Injury (RSI) scores ≥ 60/100 (low apprehension) at 6 months after injury and to identify variables independently associated with low apprehension at 6 months. Persisting apprehension may in part explain this observation. Only 65% of people return to a level of sport equivalent to that before after anterior cruciate ligament (ACL) surgery.
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