Outcomes & Rehabilitation

Post-operative rehabilitation for TKA and ACLR, focusing on criterion-based progression, psychological readiness, and return-to-sport metrics.

Overview

Rehabilitation protocols must be tailored to the specific pathology and surgical intervention to optimize outcomes. For rotator cuff tears, functional improvement plateaus after 16 physical therapy sessions [1], while aggressive early rehabilitation shows no definitive consensus for clinical superiority over standard timing in arthroscopic repair despite trends in early range of motion and pain relief [5]. In contrast, physical therapy alone for irreparable massive rotator cuff tears yields less functional improvement and higher failure rates compared to surgery [6]. For anterior cruciate ligament injuries, favorable functional and radiographic outcomes are achievable with progressive criterion-based rehabilitation regardless of operative or nonoperative management [4], and prehabilitation prior to reconstruction is safe and effective for meeting symptom state thresholds and return to sports criteria up to 10 years post-operation [19].

Outcomes for meniscus repair are independent of the specific rehabilitation regimen at 1- and 2-year follow-up [2], whereas intensive rehabilitation may safely accelerate return to competition and improve medium-term outcomes in highly competitive athletes undergoing autologous chondrocyte implantation [17]. An 8-week weightbearing protocol after matrix-induced autologous chondrocyte implantation is safe without compromising long-term results [3], and gamification with remote monitoring produces outcomes equivalent to conventional physiotherapy after arthroscopic shoulder surgery [7]. Extracorporeal shockwave therapy combined with standard rehabilitation after anterior cruciate ligament reconstruction may improve patient-reported outcomes, though clinical significance remains uncertain [9]. Early surgery and rehabilitation are encouraged for ultra-low velocity bilateral multi-ligament knee injuries to improve long-term outcomes [10], while no functional differences exist between unilateral and bilateral total knee replacement selections [43].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Total knee arthroplasty (TKA) design and alignment significantly influence joint mechanics, though a considerable difference remains between TKA kinematics and the healthy native knee [63]. Medial pivot designs provide a more native-like kinematic profile and reduced quadriceps loading compared to cruciate-retaining designs [47]. Kinematically aligned TKAs better reproduce normal gait and restore patellar kinematics and contact pressure distribution during deep flexion than mechanically aligned TKAs [71, 78]. While kinematically aligned TKAs more closely resemble normal controls, retention of the posterior cruciate ligament (PCL) alone may not achieve physiological kinematics [51, 71]. In PCL-retaining TKA, postoperative lateral laxity greater than 0.9 mm at 90-degree flexion is associated with physiological motion and fewer patient-reported symptoms [74]. Conversely, combined flexion in robotic TKA influences biomechanics, yet its direct impact on clinical outcomes remains unclear [37].

Anterior cruciate ligament (ACL) reconstruction alters knee biomechanics, primarily in the sagittal plane during side-cutting compared with the contralateral leg [50]. Landing and running mechanics are altered post-ACL reconstruction but tend to recover by 3 years; however, running biomechanics are not restored to the preinjury state by 12 months [75, 82]. Nonsurgical limb mechanics remain unchanged compared with preinjury levels [82]. Graft-specific differences in biomechanics appear to relate to the donor site [76]. Poor knee function is associated with attenuated landing force and flexion moment during running [23], whereas greater flexion excursion and moment in hopping correlate with better function [61]. Patients with lower function demonstrate hop-landing biomechanics previously linked to early patellofemoral osteoarthritis [61]. Abnormal biomechanics at 6 months predict cartilage degeneration at 3 years [75]. Despite these alterations, comparable walking and forward lunge biomechanics suggest knee pain has no substantial impact on movement up to 10 years post-surgery [83].

In osteoarthritis, knee biomechanical markers correlate with patient-reported function more strongly than X-ray grading, though both provide complementary assessment information [68]. Applying a biomechanical device to the feet of osteoarthritis patients reduces pain and improves function [69]. Neuromuscular electrical stimulation appears safe for knee joint biomechanics with no observed pathological changes [72]. Native rotational kinematics are restored after lateral unicompartmental knee arthroplasty but not after medial unicompartmental knee arthroplasty [67]. Systematic alignment simulations achieved knee balance in only 11% of knee arthroplasties [86].

Classification

Rotator Cuff Repair: Twenty-six distinct criteria described by multiple classification systems exist for the magnetic resonance assessment of rotator cuff status after repair [28]. Regarding rehabilitation timing, no definitive consensus supports a clinical difference in early healing stages for arthroscopic rotator cuff repair, despite some studies reporting trends toward improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation [5]. Outcomes for rotator cuff tears improve with physical therapy up to 16 sessions, after which they plateau [1].

Patellofemoral Pain: A classification system reflecting a consensus reached by the European Rehabilitation Panel was introduced to help clinicians identify the cause(s) of patellofemoral pain and select the most appropriate non-operative treatment [35].

Anterior Cruciate Ligament Injury: The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so [98]. In patients following the Delaware-Oslo ACL Cohort Treatment Algorithm, four distinct 5-year trajectories of patient-reported knee function were identified, with 88% of patients following Moderate and High trajectories characterized by good improvement and high scores [105].

Knee Arthroplasty: A post-operative classification of excellent, good, fair, and poor for the components and total WOMAC scores after total knee arthroplasty has been defined [91]. A distinct gait difference between differing arthroplasty types was established using a dynamic metric of an everyday activity for individuals with both a unicompartmental and total knee arthroplasty [87]. Functional outcomes and quality of life were not different between hand-held navigation and conventional instruments in total knee arthroplasty at two years [99].

Revision Knee Replacement: The revision knee complexity classification offers a common-sense approach to recognize increasing complexity in revision total knee replacement cases, providing a methodological assessment to support regional clinical networking and triage of appropriate cases to specialist centres [104].

Shoulder Arthroplasty: Six distinct early recovery trajectories were identified after total shoulder arthroplasty, with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks [100].

Other Considerations: Subjective and functional outcomes at 1- and 2-year follow-up for isolated meniscus repair were not affected by rehabilitation regimen [2]. No current MRI classification system has been shown to correlate with clinical outcomes after all types of cartilage repair surgery in the knee [66]. Further research is needed to develop updated classification systems for the posterolateral corner of the knee [22].

Clinical Presentation

Outcomes following rotator cuff repair demonstrate a plateau after 16 sessions of physical therapy [1], with the majority of functional and symptomatic improvements occurring within the first year and minimal clinically meaningful gains observed between years 1 and 2 [25]. While some studies report trends toward improved early range of motion, pain relief, and outcome scores with aggressive rehabilitation, no definitive consensus supports a clinical difference resulting from rehabilitation timing in the early stages of healing [5]. For irreparable massive rotator cuff tears, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate compared with surgery [6].

In the context of anterior cruciate ligament (ACL) injuries, favorable outcomes occur with both operative and nonoperative management when utilizing progressive criterion-based rehabilitation [4]. Extracorporeal shockwave therapy combined with standard rehabilitation may potentially lead to better patient-reported outcomes after ACL reconstruction, though these differences may not be clinically significant [9]. Early surgery and rehabilitation strategies are specifically encouraged to improve long-term outcomes in ultra-low velocity bilateral multi-ligament knee injuries [10]. Clinical interventions for meniscus injury should focus on factors influencing kinesiophobia to enhance rehabilitation outcomes [11], whereas subjective and functional outcomes at 1- and 2-year follow-up after isolated meniscus repair remain unaffected by the specific rehabilitation regimen [2].

Prognostic factors for functional outcomes vary by procedure. For primary rotator cuff repair, comorbidity, patient compliance, and regular physiotherapy are critical [32]. Following patellar instability surgery, a standardized list of objective and reproducible criteria should help practitioners focus on patient-centred factors rather than arbitrary timelines [8]. In traumatic knee dislocations, functional rehabilitation is the most important positive prognostic factor [29]. For hemiarthroplasty, comorbidity, patient compliance, and regular physiotherapy remain important prognostic factors for functional outcomes [32]. Substantial changes in discharge to rehabilitation are associated with declines in average functional outcomes, extent of therapy received, and health-related quality-of-life [16].

Specific procedures show distinct outcome trajectories. Short-stem uncemented primary reverse shoulder arthroplasty demonstrates reliable pain relief and improved movement in short-term clinical outcomes [12]. Functional outcome following open-wedge valgus high tibial osteotomy remains stable at 60 months [13], though sport recovery following high tibial osteotomy for medial osteoarthritis is multifactorial and often limited [26]. Most participants with proximal humeral fractures achieve maximum functional outcome at six months, which is maintained at five years [27]. Functional outcomes following bridge plate fixation for distal radius fractures are similar to those published for other treatment methods [30]. Final functional scores following autologous chondrocyte implantation in the patella, although significantly improved, still reflect residual disability [34].

Rehabilitation delivery methods and adjuncts also influence presentation. Gamification with remote monitoring yields outcomes equivalent to conventional physiotherapy rehabilitation protocols after arthroscopic shoulder surgery [7].

Investigations

Plain radiography: Radiographic deformity and nonsurgical treatment of distal radius fractures do not necessarily correlate with worse functional outcomes, particularly in patients over 60 years of age [55]. Radiographic severity of arthritic changes can predict knee-specific functional improvement following total knee arthroplasty, but cannot predict the extent of global functional improvement [62]. In total knee arthroplasty, differences between modified kinematic and mechanical alignment are primarily radiographic despite no significant differences in clinical or functional outcomes at 1-year follow-up [70]. Radiographic outcomes for cemented and uncemented reverse total shoulder arthroplasty differ, though both groups show very satisfying functional outcomes and low revision rates at 2 years [59].

MRI: Functional scores and radiological outcomes were improved following surgical treatment of patellar instability in children with Down syndrome [24]. Both bone marrow aspirate concentrate and mesenchymal stem cells augment microfracture to improve clinical and radiographic outcomes for cartilage lesions with osseous involvement [42]. Short-term clinical and MRI outcomes for second-generation characterized chondrocyte implantation for knee cartilage lesions are promising [46]. Superior outcomes in arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy are associated with better preoperative clinical and MRI status [53]. Needle arthroscopy and magnetic resonance imaging yield similar outcomes for the diagnosis and treatment of meniscal tears of the knee [54]. Clinical characteristics measured by KOOS and MRI findings are predictive of results in conservative treatment of MRI-verified meniscal lesions [58]. Arthroscopy and microfracture for osteochondritis dissecans of the capitellum in adolescent athletes show favorable return to sport with improved clinical, radiographic, and patient-reported outcomes [60]. Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after articular cartilage repair of the knee is lacking [65]. Positive results for the cross brace protocol for ACL rupture management are associated with favorable MRI injury classification at baseline and low level of pre-injury function and activity [77]. If detected on MRI as an isolated injury, surgical arthroscopy is unnecessary for subcortical trabecular fractures (bone bruise) in knees as patients recover well in the short term with restricted weightbearing and initial activity modification [79]. Postoperative clinical outcomes and MRI findings for autologous matrix-induced chondrogenesis rehabilitation were similar between protocols, suggesting that customizing the rehabilitation protocol to the lesion site plays a role in positive outcomes [81]. MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention [84]. Functional and radiological results after limited saucerization of a discoid lateral meniscus were superior in pediatric patients compared to other age groups [85].

Other Considerations: Adolescents showed comparable clinical and radiographic results to adult controls in the short and medium term after M-ACI, with slightly more favorable, clinically relevant functional results in adolescents in the long term [73]. Both the Metaizeau technique and percutaneous Kirschner wire fixation for radial neck fractures in children result in good clinical and radiographic outcomes in the long term [64]. Anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component demonstrated favorable long-term clinical, functional, and radiographic outcomes after 10 years [80].

Treatment

Non-Operative

Physical therapy is a primary intervention for various musculoskeletal conditions, with outcomes for rotator cuff tears improving up to 16 sessions before plateauing [1]. For irreparable massive rotator cuff tears, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate compared with surgery [6]. In the context of subacromial impingement, responders to exercise treatment achieve the best long-term outcomes, whereas subacromial decompression yields satisfying results in nonresponders [33]. Clinical interventions for meniscus injury should specifically target factors influencing kinesiophobia to enhance rehabilitation outcomes [11]. For unstable shoulders in scholastic athletes, bracing is not effective as an adjunct to standard nonoperative management for returning to complete a subsequent season [89]. Nonoperative treatment of the posterior cruciate ligament should not be extended beyond 1 year from injury [90]. In high-performance athletes with complete proximal adductor avulsion, nonoperative treatment with a healing phase and strict rehabilitation plan results in functional reattachment and unrestricted return to play [93]. Both operative and nonoperative management of grade III medial collateral ligament tears demonstrated clinical improvements at 2-year follow-up when treated concurrently with anterior cruciate ligament reconstruction [94]. For the middle-aged population with moderate activity levels, nonoperative treatment with optional delayed anterior cruciate ligament reconstruction may be the more cost-effective strategy [95]. Both nonoperative and operative treatment groups for type III and V acromioclavicular joint dislocation achieved very good restoration of shoulder function and patient satisfaction at 24 months, with operative treatment not leading to better outcomes [96]. Nonsurgical treatments for degenerative arthritis of the knee in active patients include rehabilitation and medical management, while surgical options such as arthroscopic debridement, osteotomy, and arthroplasty each have specific indications and limitations regarding symptom relief and activity return [102]. An initial trial of nonoperative management may be considered in young active patients with isolated superior labrum anterior-posterior tears [103].

Operative

Indications: Surgical intervention is indicated for irreparable massive rotator cuff tears when physical therapy fails to provide adequate functional improvement [6]. Open debridement and soft tissue release are effective for restoring motion and allowing satisfactory functional recovery in the severely arthrofibrotic knee [41]. Surgical treatment of knee dislocations improves outcomes compared to nonoperative management, though many patients remain unable to return to physical occupations or sporting activities due to injury severity [106].

Surgical Approach / Technique: For anterior cruciate ligament (ACL) injuries, favorable functional and radiographic outcomes can occur after both operative and nonoperative management using progressive criterion-based rehabilitation [4]. Prehabilitation prior to ACL reconstruction is safe and effective, yielding short- to long-term benefits by meeting or surpassing patient acceptable symptom state thresholds and return to sports criteria while maintaining functional improvements up to 10 years post-operation [19]. For failed first revision ACL reconstruction, nonsurgical management is associated with high rates of return to sport, comparable to second revision ACL reconstruction [97]. Decisions on postoperative rehabilitation for ACL reconstruction with concomitant articular cartilage lesions should be made on a case-by-case basis with criteria-based progression until more robust evidence becomes available [49]. Further prospective studies are needed to update rehabilitation guidelines regarding the impact of early weight-bearing on results following ACL reconstruction [45].

Adjuncts: Extracorporeal shockwave therapy combined with standard rehabilitation may potentially lead to better patient-reported outcomes after ACL reconstruction, but these differences may not be clinically significant [9]. Gamification with remote monitoring provides functional and radiographic outcomes equivalent to conventional physiotherapy rehabilitation protocols after arthroscopic shoulder surgery [7].

Other Considerations: An 8-week weightbearing rehabilitation protocol after matrix-induced autologous chondrocyte implantation is safe without jeopardizing longer term outcomes [3]. An accelerated rehabilitation protocol after matrix-induced autologous chondrocyte implantation is safe and effective, providing comparable, if not superior, clinical outcomes throughout the postoperative timeline [36]. Subjective and functional outcomes at 1- and 2-year follow-up for isolated meniscus repair were not affected by the rehabilitation regimen [2]. Multivariable prognostic models cannot predict which patients eligible for meniscal surgery who first receive physical therapy will eventually undergo surgery [88]. Reduction in laxity from knee extensor open kinetic chain resistance training in the ACL-injured knee does not appear to offer any significant short-term functional advantages when compared to a standard rehabilitation protocol [52]. Substantial changes in discharge to rehabilitation following Medicare bundled payments for total hip and knee arthroplasty were accompanied by declines in average functional outcomes, extent of therapy received, and health-related quality-of-life [16].

Complications

Infection (PJI): Patients who develop septic arthritis as a complication of anterior cruciate ligament reconstruction have diminished long-term subjective, functional, and radiographic outcomes compared with historical reports of uncomplicated cases [109].

Instability: Favorable functional and radiographic outcomes occur after both operative and nonoperative management of anterior cruciate ligament injuries with progressive criterion-based rehabilitation [4]. Standardized objective criteria for rehabilitation after patellar instability surgery help practitioners focus on patient-centred factors rather than arbitrary timelines [8].

Stiffness / Arthrofibrosis: Improvement in outcomes for rotator cuff tears plateaus after 16 sessions of physical therapy [1].

Other Considerations: Subjective and functional outcomes at 1- and 2-year follow-up after isolated meniscus repair are not affected by the rehabilitation regimen [2]. An 8-week weight-bearing rehabilitation protocol after matrix-induced autologous chondrocyte implantation is safe without jeopardizing longer-term outcomes [3]. Early surgery and rehabilitation strategies are encouraged to improve long-term outcomes in ultra-low velocity bilateral multi-ligament knee injuries [10]. The short follow-up period in robotic-assisted unicompartmental knee arthroplasty limits the assessment of complications, implant survivorship, and mid-to long-term functional outcomes [14]. Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [15]. Intensive rehabilitation may safely allow a faster return to competition and positively influence clinical outcomes at medium-term follow-up after arthroscopic autologous chondrocyte implantation in highly competitive athletes [17]. Long-term functional impairment should be expected after surgical treatment of posterior cruciate ligament lesions in pediatric patients [18]. One fifth of patients with psoriatic arthritis experienced deterioration of physical function over time, with joint damage and baseline physical function identified as important factors associated with poor physical function [20]. An accelerated rehabilitation programme after arthroscopic Bankart repair in professional footballers resulted in a return to play time of 11 weeks [21]. A decline in clinical outcomes from midterm to long term was noted only in sports-related scores following fresh-frozen meniscal allograft transplant with soft tissue fixation [39]. Long-term follow-up is needed to identify the lasting implications of outcome differences following reverse total shoulder arthroplasty [40]. There were no significant differences in complications between imageless robotic-assisted total knee arthroplasty and conventional total knee arthroplasty at 24-month follow-up [44]. Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment [92]. The symptoms of carpal tunnel syndrome may improve without surgery [101]. The natural history of rotator cuff tendinopathy probably plays a significant role in the results in the long term [107]. The complication incidence was relatively high after total knee arthroplasty post-high tibial osteotomy, though no knees required revision [108].

Recovery

Light activity (weeks): Return to desk work and driving is facilitated by accelerated rehabilitation programmes, which have enabled professional footballers to return to play in 11 weeks following arthroscopic Bankart repair [21]. For patients undergoing total knee arthroplasty, recovery trajectories over the first six weeks of high-intensity physiotherapy can distinguish outcomes after one year [111].

Full activity (months): Functional outcomes following arthroscopic Bankart repair reach a steady state of excellent quality-of-life and functional scores after 12 months [48]. In contrast, functional outcome scores following Grammont style reverse shoulder arthroplasty remain less predictable over time at a minimum of 10-year follow-up [115]. Reasonable long-term functional outcome scores can also be achieved following infected mini-open rotator cuff repair [31].

Complete recovery / outcome plateau (months): Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued [1]. Functional outcome was stable following 60 months after open-wedge valgus high tibial osteotomy [13]. Outcome scores improved significantly from baseline to the long-term evaluation after microfracture treatment of articular cartilage defects in the knee and were not different from the midterm outcome [56].

Rehabilitation protocol: Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen in isolated meniscus repair [2]. A safe 8-week weightbearing rehabilitation protocol does not jeopardize longer term outcomes after matrix-induced autologous chondrocyte implantation [3]. No definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing for arthroscopic rotator cuff repair [5]. Patients in the early and delayed physical therapy groups demonstrated very similar clinical outcomes and range of motion at 1 year following arthroscopic rotator cuff repair [112]. Timing of supervised physical rehabilitation initiation within the first 30 days after surgery was not significantly associated with the incidence of 12-month arthrofibrosis diagnosis or surgical intervention after isolated arthroscopic anterior cruciate ligament reconstruction [113]. Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy when nonoperative treatment of anterior cruciate ligament injury failed [110]. Successful management of rotator cuff disease is dependent on appropriate rehabilitation, which should be based on an evaluation of underlying tissue quality and structural integrity rather than solely on empirical clinical experience or fixed healing timelines [114].

Functional milestones: A standardized list of objective and reproducible criteria for rehabilitation should help practitioners focus more on patient-centred factors and less on arbitrary timelines following patellar instability surgery [8]. Patient-reported outcomes were satisfactory following the Ponseti method for untreated clubfeet in Nepalese patients seen between the ages of one and five years [57]. Long-term functional impairment should be expected following surgical treatment of posterior cruciate ligament lesions in pediatric patients [18].

Other Considerations: Short-, mid-, and long-term results indicate positive clinical outcomes following the Latarjet procedure [15]. The relatively short follow-up period limits the assessment of complications, implant survivorship, and mid-to long-term functional outcomes following fixed-bearing medial robotic-assisted unicompartmental knee arthroplasty [14]. One fifth of patients with psoriatic arthritis experienced deterioration of physical function over time [20]. Joint damage and baseline physical function are important factors associated with poor physical function in patients with psoriatic arthritis [20].

Key Evidence

• [L3] Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued. (10.1016/j.jse.2018.10.001)
• [L1] Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. (10.1177/0363546513505079)
• [L1] The outcomes of this randomized trial demonstrate a safe 8-week WB rehabilitation protocol without jeopardizing longer term outcomes. (10.1177/0363546519886548)
• [L2] Favorable outcomes can occur after both operative and nonoperative management approaches with the use of progressive criterion-based rehabilitation. (10.1177/0363546518782698)
• [L4] Although some studies report trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation, no definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing. (10.5435/jaaos-22-01-1)
• [L4] Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate. (10.1016/j.jse.2020.07.030)
• [L2] Outcomes, judged by ROM and patient-reported outcome measures, are equivalent to conventional physiotherapy rehabilitation protocols. (10.1016/j.jse.2021.08.019)
• [L5] The standardized list of objective and reproducible criteria for rehabilitation should help practitioners focus more on patient-centred factors and less on arbitrary timelines. (10.1007/s00167-019-05510-6)
• [L1] ESWT combined with standard rehabilitation may potentially lead to better patient-reported outcomes, but these differences may not be clinically significant. (10.1186/s12891-025-08277-9)
• [Case_report] The authors describe successful surgical and rehabilitation management, encouraging early surgery and rehabilitation strategies to improve long-term outcomes. (10.1016/j.jisako.2024.100332)
• [L4] Clinical interventions should focus on these factors to enhance rehabilitation outcomes. (10.1186/s13018-025-05498-5)
• [L4] Short-term clinical outcomes demonstrate reliable pain relief and improved movement. (10.1302/0301-620x.96b3.32702)
• [L4] Functional outcome was stable following 60 months. (10.1007/s00167-013-2762-y)
• [L3] However, the relatively short follow-up period limits the assessment of complications, implant survivorship, and mid-to long-term functional outcomes. (10.1186/s13018-025-06181-5)
• [L4] Short-, mid-, and long-term results indicate positive clinical outcomes. (10.1016/j.jseint.2025.04.033)
• [L4] The results demonstrate substantial changes in discharge to rehabilitation with accompanying declines in average functional outcomes, extent of therapy received, and health-related quality-of-life. (10.1016/j.arth.2019.01.068)
• [L3] Intensive rehabilitation may safely allow a faster return to competition and also influence positively the clinical outcome at medium-term follow-up. (10.1177/0363546509348490)
• [L4] Nevertheless, long-term functional impairment should be expected and close follow-up has to be recommended. (10.1007/s00167-018-5308-5)
• [L2] Current prehabilitation practices for ACLR are safe and effective, yielding short- to long-term benefits by meeting or surpassing patient acceptable symptom state thresholds and return to sports criteria while maintaining functional improvements up to 10 years post-operation. (10.1002/ksa.12631)
• [L3] One fifth of patients experienced deterioration of physical function over time, with joint damage and baseline physical function being important factors associated with poor physical function. (10.1186/1471-2474-15-284)
• [L4] An accelerated rehabilitation programme resulted in a return to play time of 11 weeks compared to previously reported times of between 5 months and 9 months in the contact sports population. (10.1177/1758573216647898)
• [L5] Further research is needed to develop updated classification systems, and better understand the role of non-invasive and minimally invasive approaches along with standardized rehabilitation protocols. (10.1007/s00167-018-5260-4)
• [L3] These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function. (10.1007/s00167-017-4810-5)
• [L4] Functional scores and radiological outcomes were improved. (10.1186/s13018-024-04730-y)
• [L4] The majority of functional and symptomatic improvements following RCR occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years. (10.1016/j.jse.2025.05.020)
• [Letter] While sport recovery is multifactorial and often limited in this setting, findings offer clinically meaningful guidance regarding expected outcomes. (10.1002/ksa.70366)
• [L1] Most participants had maximum functional outcome at six months that was maintained at five years. (10.1302/0301-620x.102b1.bjj-2020-0546.r1)
• [L4] Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair. (10.1007/s00167-014-3486-3)
• [L3] Functional rehabilitation was the most important positive prognostic factor. (10.1177/03635465020300051601)
• [L4] Functional outcomes are similar to those published for other treatment methods. (10.1016/j.jhsa.2015.05.008)
• [L4] Reasonable long-term functional outcome scores can be achieved. (10.1016/j.jse.2017.09.003)
• [L3] Comorbidity, patient compliance, and regular physiotherapy are important prognostic factors for functional outcomes. (10.1016/j.jse.2008.06.008)
• [L2] Responders to exercise treatment had the best long-term outcomes and ASD yielded satisfying outcome in nonresponders. (10.1016/j.jse.2024.10.027)
• [L4] However, final functional scores, although significantly improved, still reflected residual disability in this challenging group of patients. (10.1177/0363546514523927)
• [L5] The authors introduce a classification system reflecting a consensus reached by the European Rehabilitation Panel to help clinicians identify the cause(s) of patellofemoral pain and select the most appropriate non-operative treatment. (10.1007/s00167-004-0577-6)
• [L1] The outcomes of this randomized trial demonstrate a safe and effective accelerated rehabilitation protocol as well as a regimen that provides comparable, if not superior, clinical outcomes to patients throughout the postoperative timeline. (10.1177/0363546512445167)
• [L3] Although combined flexion influences knee biomechanics, its direct impact on clinical outcomes remains unclear. (10.1002/ksa.12660)
• [L4] Decline of clinical outcomes from midterm to long term was noted only in sports-related scores. (10.1177/0363546520932923)
• [L3] Long-term follow-up is needed to identify the lasting implications of such outcome differences. (10.1016/j.jse.2023.09.033)
• [L4] The technique effectively restores motion and allows satisfactory functional recovery. (10.1177/03635465990270050201)
• [Commentary] Both treatment options improve clinical and radiographic outcomes. (10.1016/j.arthro.2021.05.056)
• [L3] No differences in functional improvements were identified between patients who selected unilateral versus bilateral TKR, indicating no recommendation for one procedure over the other. (10.1186/s12891-018-2006-x)
• [L3] However, at 24-month follow-up, there were no significant differences in ROM, length of stay, complications, and PROMs between cohorts, indicating similar clinical outcomes. (10.1007/s00167-021-06599-4)
• [L4] Further prospective studies on this topic are needed to update rehabilitation guidelines. (10.1186/s12891-024-07525-8)
• [L4] The short-term clinical and MRI outcome are promising. (10.1007/s00167-011-1759-7)
• [L5] The MP design provides a more native-like knee kinematic profile than the CR design, with a more pronounced MP motion pattern and reduced quadriceps loading. (10.1002/ksa.12624)
• [L3] A steady state of excellent quality-of-life and functional outcomes was noted after 12 months of follow-up. (10.1016/j.arthro.2017.04.017)
• [L4] Decisions on postoperative rehabilitation should be made on a case-by-case basis with criteria-based progression until more robust evidence becomes available. (10.1007/s00167-018-4882-x)
• [L3] Knee biomechanics in the leg with ACLR were altered mainly in the sagittal plane during side-cutting compared with the contralateral leg. (10.1177/03635465221112940)
• [L3] The BCS cohort showed expected knee joint kinematics. (10.2106/jbjs.20.00024)
• [L2] This reduction in laxity does not appear to offer any significant short-term functional advantages when compared to a standard rehabilitation protocol. (10.1007/s00167-014-3110-6)
• [L4] Superior outcomes were associated with better preoperative clinical and MRI status, indicating that early recognition and timely intervention result in better shoulder motion and improved joint alignment. (10.1016/j.jse.2009.05.011)
• [L2] Outcomes were similar with NA compared with MRI. (10.1016/j.arthro.2018.09.030)
• [L4] Radiographic deformity and nonsurgical treatment do not necessarily correlate with worse functional outcomes, particularly in patients over 60 years of age. (10.1016/j.jhsa.2012.04.006)
• [L4] The outcome scores improved significantly from baseline to the long-term evaluation and were not different from the midterm outcome. (10.1007/s00167-014-3443-1)
• [L4] Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood. (10.2106/jbjs.18.00445)
• [L2] Clinical characteristics measured by KOOS and MRI findings were predictive of the results. (10.1007/s00167-013-2494-z)
• [L3] However, this was primarily a radiographic finding as both groups showed very satisfying functional outcomes and low revision rates at the 2-year follow-up. (10.1186/s12891-022-05994-3)
• [L4] Included studies reported improved clinical, radiographic, and patient-reported outcomes. (10.1016/j.arthro.2023.08.075)
• [L3] Patients with lower levels of knee function following ACLR demonstrated hop-landing biomechanics previously associated with early patellofemoral osteoarthritis. (10.1007/s00167-018-5197-7)
• [L4] Patients can be counselled that although radiographic severity of arthritic changes can predict knee-specific functional improvement, the extent of their global functional improvement cannot. (10.1007/s00167-015-3806-2)
• [L2] Furthermore, the considerable difference between TKA design and the kinematics of healthy knee were highlighted in this study. (10.1186/s42836-023-00165-8)
• [L3] Nevertheless, both techniques resulted in good clinical and radiographic outcomes in the long term, making them viable treatment options. (10.1186/s12891-025-08830-6)
• [L1] Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after cartilage repair is lacking. (10.1177/0363546512473258)
• [L1] No current MRI classification system has been shown to correlate with clinical outcomes after all types of cartilage repair surgery. (10.1177/0363546513485931)
• [L5] The rotational kinematics of the native knee was not restored after medial UKA but was preserved after lateral UKA. (10.1007/s00167-018-4919-1)
• [L2] Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. (10.1186/s12891-022-05845-1)
• [L2] The biomechanical device and treatment methodology is effective in significantly reducing pain and improving function in knee OA patients. (10.1186/1471-2474-11-179)
• [L1] This study found no significant differences in clinical or functional outcomes between KA and MA despite distinct radiological alignment outcomes after 1-year follow-up. (10.1002/ksa.70004)
• [L3] The knee kinematics of patients with kinematically aligned TKAs more closely resembled that of normal healthy controls than that of patients with mechanically aligned TKAs. (10.1007/s00167-018-5174-1)
• [L2] The neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint with no pathological changes in knee function observed. (10.1155/2013/802534)
• [L3] Adolescents showed comparable clinical and radiographic results in the short and medium term, with slightly more favourable, clinically relevant functional results in adolescents in the long term. (10.1002/ksa.12359)
• [L3] Postoperative lateral laxity greater than 0.9 mm at 90-degree flexion was associated with physiological kinematic motion, leading to fewer knee symptoms in the PROMs. (10.1016/j.jisako.2024.100357)
• [L2] Landing biomechanics are altered after ACLR but biomechanical abnormalities tend to recover at 3 years after ACLR. (10.1016/j.arthro.2018.07.033)
• [L3] There are graft-specific differences in knee biomechanics after anterior cruciate ligament reconstruction that appear to relate to the donor site. (10.1177/0363546504266483)
• [L2] Positive results were associated with favourable MRI injury classification at baseline and low level of pre-injury function and activity. (10.1177/2325967126s00013)
• [L5] Kinematically aligned TKA better restores patellar kinematics and PF contact pressure distribution to the native condition than mechanically aligned TKA during deep knee flexion. (10.1007/s00167-018-5270-2)
• [L4] If detected on MRI as an isolated injury, surgical arthroscopy is unnecessary since these patients can be expected to recover well in the short term with restricted weightbearing and initial activity modification. (10.1177/03635465000280050701)
• [L4] This study demonstrated favorable long-term clinical, functional, and radiographic outcomes of aTSA after 10 years. (10.1016/j.jse.2025.03.036)
• [L4] Postoperative clinical outcomes and MRI findings were similar with both protocols, suggesting that customizing the rehabilitation protocol to the lesion site plays a role in positive outcomes. (10.1177/23259671251391794)
• [L2] After ACLR, surgical limb knee running biomechanics were not restored to the preinjury state by 12 months, while nonsurgical limb mechanics remained unchanged as compared with preinjury. (10.1177/03635465211026665)
• [L3] The comparable walking and forward lunge biomechanics suggest that knee pain has no substantial impact on movement biomechanics up to 10 years post‐surgery. (10.1002/ksa.12630)
• [L3] MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention. (10.2106/jbjs.n.00947)
• [L4] Functional and radiological results were superior in the pediatric patients. (10.1177/03635465241313137)
• [L4] Systematic alignment simulations achieved knee balance in only 11% of cases. (10.1007/s00167-022-07252-4)
• [L3] A distinct gait difference between differing arthroplasty types was established using a dynamic metric of an everyday activity. (10.1007/s00167-019-05814-7)
• [L2] The non-responders to physical therapy could not accurately be predicted by our prognostic models. (10.1007/s00167-021-06468-0)
• [L3] Bracing is not effective as an adjunct to standard nonoperative management in allowing athletes to return and complete a subsequent season. (10.1016/j.jse.2018.02.027)
• [L4] Nonoperative treatment should not be extended more than 1 year from injury. (10.1177/0363546509333479)
• [L3] This study has defined a post-operative classification of excellent, good, fair and poor for the components and total WOMAC scores after TKA. (10.1007/s00167-018-4879-5)
• [L2] Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment. (10.1016/j.jse.2024.05.056)
• [L4] Nonoperative treatment with a healing phase and a strict rehabilitation plan results in a functional, efficient reattachment of the tendon and allows unrestricted return to play. (10.1007/s00167-015-3669-6)
• [L3] Both operative and nonoperative management of MCL tears demonstrated clinical improvements between study enrollment and 2-year follow-up. (10.1016/j.arthro.2018.10.138)
• [L1] On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective strategy in the middle age population with moderate activity levels. (10.1007/s00167-022-07087-z)
• [L1] Both the nonoperative and operative treatment groups had very good restoration of shoulder function and patient satisfaction at 24 months, and operative treatment did not lead to better outcomes compared with nonoperative treatment. (10.1016/j.jse.2021.12.003)
• [L3] Both second RACLR and nonsurgical management of failed first RACLR were associated with high rates of return to sport. (10.1177/03635465221119202)
• [L3] The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so. (10.1177/0363546507308190)
• [L1] Functional outcomes and quality of life were not different between the groups at two years. (10.1186/s12891-022-05872-y)
• [L2] Six distinct early recovery trajectories were identified after total shoulder arthroplasty, with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks. (10.1016/j.jse.2025.06.016)
• [L3] The symptoms of carpal tunnel syndrome may improve without surgery, but further studies are needed to understand the natural history of the disorder. (10.1177/1753193411410155)
• [L5] Nonsurgical treatments include rehabilitation and medical management, while surgical options such as arthroscopic debridement, osteotomy, and arthroplasty each have specific indications and limitations regarding symptom relief and activity return. (10.5435/00124635-199911000-00005)
• [L3] An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear. (10.1016/j.jse.2015.09.008)
• [L5] The revision knee complexity classification offers a common-sense approach to recognize increasing complexity in revision TKR cases, providing a methodological assessment to support regional clinical networking and triage of appropriate cases to specialist centres. (10.1007/s00167-019-05462-x)
• [L3] Four distinct 5-year trajectories of patient-reported knee function were identified, with 88% of patients following Moderate and High trajectories characterized by good improvement and high scores. (10.1177/03635465221116313)
• [L5] Surgical treatment of knee dislocations improves outcomes compared to nonoperative management, yet many patients remain unable to return to physical occupations or sporting activities due to the severity of injuries and associated trauma. (10.1016/j.arthro.2018.02.010)
• [L1] The natural history of rotator cuff tendinopathy probably plays a significant role in the results in the long-term. (10.1302/0301-620x.99b6.bjj-2016-0569.r1)
• [L4] The authors' early experience showed improved functional and radiological outcomes; however, the complication incidence was relatively high, but no knees required revision. (10.1186/s13018-023-04199-1)
• [L4] Patients who develop septic arthritis as a complication of ACL reconstruction surgery have diminished long-term subjective, functional, and radiographic outcomes compared with historical reports of uncomplicated cases, likely related to pain from advanced arthritis. (10.1177/0363546512461903)
• [L3] Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy. (10.1177/03635465211068532)
• [L3] These recovery trajectories can distinguish outcome after one year. (10.1186/s12891-021-04037-7)
• [L1] Patients in the early and delayed groups demonstrated very similar clinical outcomes and range of motion at 1 year. (10.1016/j.jse.2012.01.025)
• [L3] Timing of supervised physical rehabilitation initiation within the first 30 days after surgery was not significantly associated with the incidence of 12-month arthrofibrosis diagnosis or surgical intervention. (10.1016/j.arthro.2024.12.004)
• [L5] Successful management of rotator cuff disease is dependent on appropriate rehabilitation, which should be based on an evaluation of underlying tissue quality and structural integrity rather than solely on empirical clinical experience or fixed healing timelines. (10.5435/00124635-200610000-00002)
• [L4] Functional outcome scores were less predictable over time. (10.1177/17585732251331474)

See Also

• Anterior Cruciate Ligament
• Total Knee Replacement
• Biomechanics

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