PT Inquest 411: Home Vs. In-Person Care After ACLR... Again
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Aug 26, 2025 Nick Koch, a physical therapist from the University of Utah Health, specializes in post-op rehab and works with athletes and incarcerated youth. He shares insights on the ongoing debate of home-based versus in-person rehabilitation after ACL reconstruction, with a focus on the importance of structured recovery. The conversation includes humorous anecdotes about eating contests, critiques of rehabilitation practices, and the psychological aspects of recovery. The discussion also delves into the risks of premature discharge and the need for tailored approaches in recovery management.
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Patient Denial Sparked The Episode
- Nick treated a 26-year-old male after quad-tendon ACLR who was denied extra PT by insurance.
- The denial cited papers that motivated Nick to bring this topic to the podcast.
Trial Design And Outcomes Focus
- The RCT compared intensive supervised PT (~17 sessions over 3 months) to a home program with four education visits.
- Primary outcomes focused on ROM and secondary on laxity and strength measured mainly as limb symmetry index (LSI).
Supervise If Strength Or Sport Demands Are High
- Don't rely on minimal early visits after ACLR if the patient has substantial strength deficits or high activity goals.
- Provide closer supervision and objective strength testing when return-to-sport demands are high.
