Early Functional Outcomes of Arthroscopic Anterior Cruciate Ligament Reconstruction Following a Structured Home-Based Rehabilitation Protocol: A Prospective Observational Study

Background: Rehabilitation is essential after anterior cruciate ligament reconstruction (ACLR), yet repeated hospital-based physiotherapy may be difficult for patients who live far from specialist centers.Evidence supporting appropriately selected home-based care exists, but early outcomes and adherence-related symptoms require careful evaluation in routine clinical settings.Objective: This study aimed to assess short-term functional recovery after arthroscopic ACLR followed by a structured 12-week home-based rehabilitation protocol and to explore clinical factors associated with nonadherence.Methods: This prospective observational study enrolled 20 adults aged 18-45 years with an isolated complete anterior cruciate ligament (ACL) tear at the Department of Orthopaedics of Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital in New Delhi, India, from April 2023 to June 2024.All participants underwent single-bundle arthroscopic ACLR using a quadrupled semitendinosusgracilis autograft and received a phased home exercise program.Lysholm Knee Score and International Knee Documentation Committee (IKDC) subjective scores were recorded preoperatively and at one, two, and three months.Repeated observations were assessed using the Friedman test for Lysholm scores and repeatedmeasures analysis of variance for IKDC scores.Exact categorical comparisons examined associations between adherence and age, sex, postoperative infection, persistent pain, and giving-way symptoms.Results: Participants had a mean age of 26.10±6.32years; 18 (90%) were male.The mean Lysholm score improved from 41.65±1.79preoperatively to 78.80±5.67 at three months (χ²=60.0;p<0.001).The mean IKDC score increased from 35.11±2.79 to 60.69±2.65 (F=100.7;p<0.001).At three months, 17 participants (85%) had a fair and three (15%) a good Lysholm category.Three participants (15%) were non-adherent.Nonadherence was associated with persistent pain at three months (p=0.016;Cramer's V=0.79) and giving-way sensation at one month (p=0.004;Cramer's V=0.84), but not with age or sex.No postoperative infection occurred.Conclusion: A structured home-based protocol after arthroscopic ACLR was accompanied by substantial early improvement in patient-reported knee function.Persistent pain and early giving-way were strong markers of non-adherence in this small cohort.The findings support structured education, planned symptom surveillance, and timely escalation to supervised care, while larger controlled studies with longer follow-up are needed before comparative effectiveness can be inferred.