Association of Systematic Nursing Care with Early Functional Recovery and Pain Control after Anterior Cruciate Ligament Reconstruction: A Cohort Study

Summary

Compared with routine care, a structured systematic nursing program was associated with better early functional recovery, lower early pain scores, quadriceps strength, inflammatory profiles, psychological status, and complication event burden during the first postoperative month after arthroscopic ACL reconstruction. These short-term findings support the clinical value of personalized, staged perioperative nursing management.

Abstract

To evaluate the impact of a structured nursing program on short-term recovery following arthroscopic anterior cruciate ligament reconstruction, patients were divided into a structured nursing care group (intervention, n = 47) and a routine nursing care group (control, n = 46). The nursing program was implemented for 1 month postoperatively, and comparative outcome analyses were based on assessments performed preoperatively, at 2 weeks, and at 1 month after surgery. The intervention consisted of preoperative assessment and education, intraoperative coordination, staged rehabilitation guidance, multimodal pain management, psychological support, complication-prevention nursing, and scheduled short-term follow-up. Outcomes were assessed at predefined time points and included knee function (Lysholm score), proprioception, knee range of motion, pain (VAS and NRS), quadriceps strength, and psychological status (SAS and SDS). Serum IL-6, TNF-α, and CRP were measured, along with extracellular matrix remodeling markers (MMP-9, MMP-13, TIMP-1, and their ratios). Baseline characteristics were similar between the two groups. At 1 month, the intervention group had higher Lysholm scores than the control group (82.85 ± 5.70 vs. 74.52 ± 7.22; MD = 8.33, 95% CI: 5.65–11.01), better proprioception (MD = 7.57, 95% CI: 5.36–9.78), and greater knee flexion (MD = 11.63°, 95% CI: 8.09–15.16), whereas knee extension did not differ significantly. Pain scores were lower in the intervention group at 2 weeks, with mean differences of -1.59 for VAS and -1.02 for NRS. The intervention group also showed lower inflammatory marker levels, a more favorable MMP/TIMP-1 balance, better quadriceps strength grading, lower SAS and SDS scores, and a lower complication event burden (17.02 vs. 39.13 events per 100 patients; RR = 0.43, 95% CI: 0.21–0.90). Overall, systematic nursing care was associated with improved short-term functional recovery, lower early pain scores, and reduced complication event burden after ACL reconstruction.

Introduction

The anterior cruciate ligament (ACL) is a principal stabilizer of the knee. ACL rupture is frequently encountered after sports-related injury, but high-energy trauma, such as traffic accidents is also a recognized cause^1,2. Once the ligament is disrupted, tibiofemoral mechanics and load transmission are altered, and patients commonly report instability, reduced activity tolerance, and pain that may persist during daily tasks³. For moderate-to-severe ACL tears, arthroscopic reconstruction is widely used. The procedure provides clear intra-articular visualization, limits additional soft-t....

Protocol

Ethics approval and study design
This study was conducted in accordance with the institutional requirements for human-subject research and was approved by the Institutional Ethics Committee of Ganzhou People's Hospital (approval No. 2025-GPH-326-23). Written informed consent was obtained from all participants before enrollment. This was a single-center prospective cohort study. Patients in the intervention and control groups were enrolled concurrently, and the structured nursing pathway was introduced into routine clinical practice in 2025. Group classification was determined by the postoperative nursing pathway actually received and was com....

Results

Comparison of knee function, proprioception, and range of motion
Baseline values were comparable between the two groups for knee function, proprioception, and range of motion (all P > 0.05). At 1 month after surgery, the intervention group showed a higher Lysholm score than the control group (82.85 ± 5.70 vs. 74.52 ± 7.22; MD = 8.33, 95% CI: 5.65 to 11.01; P < 0.001; Cohen’s d = 1.28). Proprioception was also better in the intervention group (83.81 ± 4.10 vs. 76.24 ± 6.40; MD = 7.57, 95% CI: 5........

Discussion

This cohort study showed better early recovery after arthroscopic ACL reconstruction in patients managed with a structured, staged nursing pathway than in those receiving routine care. At 1 month, the intervention group had higher Lysholm scores (82.85 ± 5.70), higher proprioception scores (83.81 ± 4.10), and greater knee flexion (125.15 ± 9.25)° than the control group, while knee extension remained similar. In the first postoperative month, improvements in flexion and functional performance often det.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Arthroscopy system	Arthrex Inc.	Synergy Arthroscopy System	Used for arthroscopic ACL reconstruction and intra-articular inspection. (Alternative: Smith & Nephew 4K Ultra Arthroscopy System)
Autologous hamstring tendon graft	Not applicable	Autologous graft	Used for primary ACL reconstruction in all patients.
Centrifuge	Eppendorf AG	5810R Refrigerated Benchtop Centrifuge	Used to separate serum after blood clotting. (Alternative: Thermo Fisher Scientific Sorvall Legend X1R)
Cold compression/ice therapy device or ice pack	Breg Inc.	Polar Care Cube Cold Therapy System	Used for swelling and pain control during early postoperative care.
CRP assay kit	R&D Systems (Bio-Techne)	Human CRP Quantikine ELISA Kit (DCRP00)	Used to measure serum C-reactive protein levels.
Crutches	Medline Industries	MDS80510 Aluminum Adjustable Axillary Crutches	Used for safe transfer, gait training, and weight-bearing control.
Doppler ultrasonography system			Used to confirm suspected deep venous thrombosis when clinically indicated.
Elastic compression dressing	3M Healthcare	Coban 1582 Self-Adherent Wrap (2" width)	Applied after incision closure for compression and wound protection.
Goniometer	Baseline (Fabrication Enterprises)	12-1000 360° Plastic Goniometer	Used to measure knee flexion and extension angles.
IL-6 assay kit	R&D Systems (Bio-Techne)	Human IL-6 Quantikine ELISA Kit (D6050)	Used to measure serum interleukin-6 levels.
Knee brace	DonJoy Orthopedics (DJO Global)	Defiance III Post-Op ACL Brace	Used during postoperative protection and rehabilitation instruction.
Knee magnetic resonance imaging (MRI) system	Siemens Healthineers	Magnetom Aera 1.5T	Used to confirm ACL injury before enrollment. (Alternative: GE Healthcare Signa HDxt 3.0T)
Lysholm Knee Function Scoring Scale	Not applicable	Validated clinical scale	Primary outcome measure for knee function.
Manual Muscle Testing (MMT) scale	Not applicable	0–5 grading scale	Used to grade quadriceps femoris muscle strength.
MMP-13 assay kit	R&D Systems (Bio-Techne)	Human MMP-13 Quantikine ELISA Kit (DMP1300)	Used to measure serum matrix metalloproteinase-13 levels.
MMP-9 assay kit	R&D Systems (Bio-Techne)	Human MMP-9 Quantikine ELISA Kit (DMP900)	Used to measure serum matrix metalloproteinase-9 levels.
Numeric Rating Scale (NRS)	Not applicable	Validated pain scale	Used to assess postoperative pain.
PASS sample size software	NCSS, LLC	PASS 15.0	Used for sample size estimation.
Proprioceptive Function Rating Scale	Not applicable	Validated clinical scale	Used to assess joint position sense and motor sense.
Self-Rating Anxiety Scale (SAS)	Not applicable	Validated psychological scale	Used to assess anxiety symptoms.
Self-Rating Depression Scale (SDS)	Not applicable	Validated psychological scale	Used to assess depressive symptoms.
SPSS statistical software	IBM Corp.	Version 26.0	Used for statistical analysis.
Surgical drain	Cardinal Health	Jackson-Pratt 10Fr Silicone Flat Drain	Placed after reconstruction according to routine practice.
TIMP-1 assay kit	R&D Systems (Bio-Techne)	Human TIMP-1 Quantikine ELISA Kit (DTM100)	Used to measure serum tissue inhibitor of metalloproteinase-1 levels.
TNF-α assay kit	R&D Systems (Bio-Techne)	Human TNF-α Quantikine HS ELISA Kit (DTA00C)	Used to measure serum tumor necrosis factor-α levels (high-sensitivity version optimized for serum samples).
Venous blood collection tubes	BD Biosciences	Vacutainer 367895 Serum Separator Tubes (SST, 5mL, Red/Gray Cap)	Used to collect fasting venous blood samples.
Visual Analog Scale (VAS)	Not applicable	Validated pain scale	Used to assess postoperative pain.