Is physical therapy more beneficial than unsupervised home exercise in treatment of post surgical knee disorders? A systematic review.

Physical therapy is common following a knee surgery. With rising healthcare costs there is debate as to the appropriateness of outpatient physical therapy following such interventions. Many of the existing controlled trials have concluded that there is no benefit to subjects that receive supervised physical therapy when compared to subjects that perform their exercises at home. The purpose of this systematic review was to consider the existing evidence regarding benefit following knee surgery and evaluate the quality, internal and external validity of such evidence. Ten studies, all randomized control trials, were found to be applicable to our review. Using the PEDro scale all studies were considered at least moderate in quality. Many of the studies had designs that biased the home exercise group, providing supervision similar to that provided by outpatient physical therapy. In select young and healthy population with few co morbidities supervised physical therapy is no more beneficial than a home exercise program following relatively simple knee surgical procedures (arthroscopic meniscetomy). However there is a lack of evidence regarding older populations with co morbidities or for more complicated knee surgical procedures (ACL reconstruction, Total Knee Arthroplasty) prohibiting a conclusion at this time for these populations and/or these procedures.