Late-stage anterior cruciate ligament reconstruction rehabilitation in the United Kingdom: an online survey of National Health Service physiotherapists

TL;DR

UK NHS physiotherapists face resource and confidence challenges in late-stage ACL-R rehabilitation, affecting return to sports decisions.

Contribution

First survey evaluating NHS physiotherapists' resources and confidence in late-stage ACL-R rehabilitation and RTS testing in the UK.

Findings

Most physiotherapists lack confidence in psychological readiness evaluation and RTS testing.

Resources for sports-specific drills and psychological evaluation are insufficient.

Non-evidence-based RTS tests are commonly used.

Abstract

Late-stage Anterior Cruciate Ligament reconstruction (ACL-R) rehabilitation aims to help patients to return to sports (RTS) and their previous activity levels and minimise reinjury rates. In the United Kingdom, National Health Service (NHS) physiotherapists lead post-ACL-R rehabilitation programs. This survey aimed evaluate NHS physiotherapists’ perspectives of the resources available, and their confidence to deliver, late-stage ACL-R rehabilitation. The secondary aim was to identify the RTS tests conducted by NHS physiotherapists on ACL-R patients.

An online cross-sectional survey of NHS physiotherapists was conducted. Proportions and percentages summarised respondents’ perspectives of the resources (equipment, space, and time) available, and their confidence, to deliver late-stage ACL-R rehabilitation components (strength testing, Neuromuscular control, movement quality analysis, plyometrics, sports specific drills, and psychological readiness evaluation) and RTS testing. Spearman signed rank test evaluated the strength and direction of any correlation between physiotherapists’ perspectives of available resources, clinical experience, and their confidence to perform late-stage rehabilitation. The RTS tests used across each component of late-stage ACL-R rehabilitation were recorded.

102 physiotherapists completed the online survey between June-July 2022. Approximately half of respondents (53%) believed most ACL-R patients (>60%) RTS. Approximately half to three quarters of respondents agreed that there were adequate resources available to perform strength (range of 49-60% respondents agreed), neuromuscular control (63-72%), movement quality analysis (53-56%) and plyometric (48-52%) components of late-stage ACL-R rehabilitation. Less than half of respondents agreed there were sufficient resources to perform sports specific drills (18%-38%), psychological readiness evaluation (20-46%), and RTS testing (26%-33%). Most respondents were confident to deliver the exercise-based components of ACL-R late-stage rehabilitation (e.g. strength testing; range 68-92%) and decide when patients were ready to RTS (75%). Conversely, most respondents were not confident to perform psychological readiness evaluation, which was moderately positively correlated with their perspectives of resources. Respondents used a wide variety of non-evidence based RTS tests across all components of late-stage ACL-R rehabilitation.

Targeted training in evidence based late-stage rehabilitation ACL-R protocols and improved access to appropriate resources maybe required to enable NHS physiotherapists to deliver optimal late-stage ACL-R rehabilitation.

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The online version contains supplementary material available at 10.1186/s13102-025-01438-2.

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