For young adults with persistent knee pain after ACL reconstruction, a supervised physical therapy program offers clearer short-term relief than handing patients a list of exercises, according to a randomized trial published in Annals of Internal Medicine. The study enrolled 184 patients aged 18-40 who were 9-36 months post-surgery and had Knee Injury and Osteoarthritis Outcome Score (KOOS) values below 80.
At 4 months, the supervised group improved by 14.1 points on the KOOS scale versus 9.4 in the self-directed group. By 12 months, the control group largely caught up, but the primary endpoint was prespecified at 4 months, and the authors concluded that physiotherapist-supervised exercise and education should be recommended. An accompanying editorial called the results a path forward that aligns with existing consensus statements and carries low risk.
The trial addresses a longstanding gap: despite the high burden of persistent pain and early osteoarthritis risk in younger patients, no evidence-informed rehab interventions existed for this stage. Secondary outcomes favored supervised rehab at 4 months, though cartilage parameters did not differ between groups. The supervised program included twice-weekly physiotherapist-led sessions plus education, while controls received an instructional booklet and a single education session.