Telerehabilitation: A Cost-Effective Alternative for ACL Recovery?

A new non-inferiority randomized trial shows a 12-week in‑home telerehabilitation program is non-inferior to standard in‑clinic physiotherapy for functional recovery after arthroscopic ACL reconstruction, supporting remote rehab as a practical option when access is limited.

The trial randomized 68 adults after arthroscopic ACL reconstruction to either a 12‑week in‑home telerehabilitation pathway or standard face‑to‑face physiotherapy. Assessments occurred at baseline, 6 weeks and 12 weeks, with the International Knee Documentation Committee functional score specified as the primary endpoint at 12 weeks. Randomized allocation, standardized exercise protocols across arms, and scheduled blinded assessments minimized selection and measurement bias.

In terms of the primary outcomes, the study met its non-inferiority endpoint for IKDC scores at 12 weeks, with a between-group difference of 0.15 (95% CI −5.81 to 6.11), well within the prespecified margin. Pain scores and range-of-motion measures were also comparable at 12 weeks, and an ITT sensitivity analysis with multiple imputation preserved the result—supporting equivalent short-term clinical endpoints in this cohort.

When it came to adherence and patient experience, session completion averaged 5.2 sessions/week in the telerehabilitation arm versus 5.1 in the face-to-face arm. Patient‑reported satisfaction was comparable (mean ≈8.7/10), and adverse events were balanced between groups. Reported implementation limitations were minor—infrequent connectivity interruptions and occasional app-installation issues—indicating feasible engagement with targeted tech support.

Operationally, the combined clinical and economic findings have direct implications for service models and payer decisions. The evidence supports considering telerehabilitation where infrastructure and patient selection permit, with attention to integration and monitoring during initial rollout.

Key Takeaways:

• Telerehabilitation produced similar IKDC improvements at 12 weeks and equivalent pain and ROM outcomes in an uncomplicated, post-arthroscopic ACL cohort. Programs can consider remote protocols for standard post‑op pathways.
• The trial’s economic analysis reported substantial per‑patient savings driven by lower therapy and transportation costs (average total cost ≈58,303 CNY for telerehab versus 82,359 CNY for face‑to‑face). Health systems and payers evaluating value‑based pathways should factor these savings into post‑op planning.
• Comparable adherence and satisfaction suggest feasible implementation, but limited tech failures and the requirement for baseline digital access indicate the need for tech support, selective patient enrollment, and standardized progression protocols. Pilot integration with clear monitoring metrics is recommended before broad rollout.
• These data support adopting telerehabilitation as a value‑preserving alternative for appropriate patients; health systems should pilot local integration with predefined monitoring metrics to confirm outcomes and savings in practice.