Predictors of Functional Recovery after Arthroscopic Anterior Cruciate Ligament Reconstruction

Open Access

Abstract

Background: Arthroscopic anterior cruciate ligament reconstruction (ACLR) is a standard procedure to restore knee stability and function after ACL rupture. Functional recovery is influenced by multiple surgical, physiological, and psychosocial factors, yet predictors of optimal outcomes remain incompletely defined. Aim of the study: To identify clinical, surgical, and psychosocial predictors of excellent functional recovery following arthroscopic ACL reconstruction. Methods & Materials: A prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from September 2022 to March 2025. Forty-four patients with isolated ACL tears were enrolled and categorized into early (<3 weeks) and delayed (>3 weeks) surgery groups. All patients underwent standardized arthroscopic ACLR and rehabilitation. Functional outcomes were evaluated using Lysholm and Tegner scores and range of motion (ROM). Predictor variables included BMI, smoking, graft diameter, rehabilitation compliance, quadriceps strength, psychological readiness, prehabilitation, and time to return to sport. Data were analyzed using SPSS version 26, including descriptive statistics, chi-square tests, t-tests, univariate analysis, and multivariable logistic regression to identify independent predictors of excellent functional recovery. Result: The overall rate of excellent functional recovery was 56.8%. Multivariable analysis revealed that good rehabilitation compliance (OR 4.56, p<0.001), graft diameter ≥7.5 mm (OR 3.84, p=0.002), quadriceps strength ≥80% (OR 3.78, p=0.004), high psychological readiness (OR 4.01, p=0.001), non-smoking status (OR 3.42, p=0.003), and prehabilitation (OR 2.96, p=0.012) were significant independent predictors. Early surgery showed a positive trend but did not reach statistical significance (OR 2.14, p=0.069). Postoperative complications were minimal and comparable between groups. Conclusion: Functional recovery after ACLR is multifactorial, with rehabilitation adherence, graft size, quadriceps strength, psychological readiness, smoking status, and prehabilitation being key predictors of excellent outcomes. Integrating structured rehabilitation, preoperative conditioning, and psychological support is essential to optimize recovery, facilitate return to activity, and maintain long-term knee stability.