Introduction Better two-year outcomes are achieved when anterior cruciate ligament reconstruction (ACLR) is combined with progressive preoperative and postoperative rehabilitation than with usual care, but long-term outcomes are not investigated. We therefore compared patient-reported outcomes 10 years after ACLR in patients who followed progressive preoperative and postoperative rehabilitation versus those who followed usual care.

Materials and Methods We included patients from the Norwegian arm of the Delaware-Oslo ACL cohort (progressive preoperative and postoperative rehabilitation, n=101) and the Norwegian Knee Ligament Registry (usual care, n=3162). Patients had primary unilateral ACLR using a patellar tendon or hamstring autograft after 2006, no substantial concomitant injuries, and were aged 13–40 years. The 10-year Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores and proportion exceeding the patient-acceptable symptom state (PASS) threshold were compared with one-way analysis of covariance (adjusted for sex, age, time to surgery, and cartilage/meniscus injury at ACLR) or chi-square tests (α=0.05).

Results Eighty-three (83%) and 1477 (53%) patients attended the 10-year follow-up. Patients who received progressive preoperative and postoperative rehabilitation had superior outcomes for KOOS pain, symptoms, activities of daily living, sports and recreation compared with usual care (p<.001), with the largest difference in sports and recreation (13±6 points). A greater proportion also exceeded the PASS-threshold compared to patients who received usual care (53–97% versus 38–83%, p≤.003).

Conclusion Ten years after ACLR, patients who received progressive preoperative and postoperative rehabilitation had better knee function and symptoms, and a greater proportion achieved acceptable symptoms compared to patients who underwent usual care.