The efficacy and cost-effectiveness analysis of telerehabilitation for patients after arthroscopic ACL-reconstruction: a non-inferiority randomized controlled trial

Abstract Purpose This study aimed to assess the clinical and cost-effectiveness of telerehabilitation (TELE) compared to face-to-face rehabilitation (FTF) in patients following arthroscopic ACL reconstruction. Given the increasing demand for accessible rehabilitation methods, this trial investigates the feasibility of implementing TELE in a middle-income country like China. Methods A prospective, randomized controlled trial (RCT) was conducted with 68 participants randomly assigned to either TELE or FTF rehabilitation. Participants were followed for 12 weeks, with assessments at baseline, 6 weeks, and 12 weeks after surgery. Primary outcomes included knee function (measured using the International Knee Documentation Committee Subjective Knee Form, IKDC). Secondary outcomes included pain, mobility, and functional status. Cost-effectiveness was analyzed using the incremental cost-effectiveness ratio (ICER). Results Both groups showed similar improvements in clinical outcomes, with no significant differences in IKDC scores, pain levels, or range of motion at 12 weeks. However, TELE rehabilitation was significantly less expensive, with a total cost of 58,303.18 CNY compared to 82,358.90 CNY for FTF (p < 0.001). The ICER analysis demonstrated that TELE was a cost-effective alternative, with substantial cost savings per unit of effectiveness. Conclusion Telerehabilitation offers a cost-effective and clinically comparable alternative to traditional face-to-face rehabilitation following ACL reconstruction. These findings support the broader implementation of TELE in regions with limited access to in-person rehabilitation, especially in low- and middle-income countries like China. Further studies with longer follow-up periods are needed to confirm the long-term cost-effectiveness and health benefits of TELE.