ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicInnovative Strategies to Prevent Cartilage, Meniscus, Ligament, and Bone Degeneration: From Oxidative Stress Modulation to Protective and Regenerative TherapiesView all 3 articles
Smart-Monitoring–Guided Rehabilitation Improves Early Functional Recovery and Reduces Complications After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study
Provisionally accepted
- First Affiliated Hospital of Hebei North University, Zhangjiakou, China
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Background: Postoperative rehabilitation critically determines functional outcomes after anterior cruciate ligament (ACL) reconstruction. Conventional programs often lack real-time feedback and objective monitoring, limiting adherence and recovery efficiency. Smart-monitoring systems integrating wearable sensors and mobile applications may enhance rehabilitation through continuous supervision and data-driven optimization. Methods: In this prospective observational cohort study, 170 patients undergoing primary ACL reconstruction (85 smart-monitoring, 85 conventional) were followed for 12 weeks. The smart-monitoring cohort used a mobile app with wearable sensors to track range of motion (ROM), training frequency, and pain feedback, whereas the control cohort performed standard home-based rehabilitation. Primary outcomes included good functional recovery (IKDC ≥80 or ROM ≥120°) and longitudinal changes in IKDC, Lysholm, and muscle strength. Logistic regression identified independent predictors, and receiver operating characteristic (ROC) curves evaluated model performance. Results: The smart-monitoring cohort achieved significantly greater improvements in IKDC, Lysholm, ROM, and quadriceps strength (all P < 0.01), faster pain reduction, and fewer complications (4.9% vs. 16.7%, P = 0.02). Rehabilitation adherence was markedly higher (91.3% vs. 73.8%, P < 0.001). Smart intervention (OR = 0.32, 95% CI: 0.14–0.70, P = 0.004) and adherence ≥85% (OR = 0.45, 95% CI: 0.21–0.92, P = 0.030) were independent protective factors for good recovery. The predictive model integrating smart intervention, adherence, and preoperative IKDC achieved the highest discriminative power (AUC = 0.88, 95% CI: 0.81– 0.93). Conclusions: Smart-monitoring–guided rehabilitation significantly accelerates functional recovery, enhances adherence, and reduces postoperative complications after ACL reconstruction. The combined smart–clinical model provides strong predictive accuracy for favorable outcomes, supporting the role of digital rehabilitation in precision recovery management.
Keywords: adherence, Anterior Cruciate Ligament Reconstruction, complications, Digital rehabilitation, functional recovery, predictive model, prospective cohort, Smart monitoring
Received: 02 Nov 2025; Accepted: 12 Jan 2026.
Copyright: © 2026 Ying, Xianhong, Liwen, Guoqing and Yongli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia Yongli
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