{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:28:35Z","timestamp":1792610915635,"version":"4.5.0"},"reference-count":52,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to assess the clinical and cost-effectiveness of telerehabilitation (TELE) compared to face-to-face rehabilitation (FTF) in patients following arthroscopic ACL reconstruction. Given the increasing demand for accessible rehabilitation methods, this trial investigates the feasibility of implementing TELE in a middle-income country like China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, non-inferiority randomized controlled trial (RCT) was conducted with 68 participants randomly assigned to either TELE or FTF rehabilitation. Participants were followed for 12\u00a0weeks, with assessments at baseline, 6\u00a0weeks, and 12\u00a0weeks after surgery. Primary outcomes included knee function (measured using the International Knee Documentation Committee Subjective Knee Form, IKDC). Secondary outcomes included pain, mobility, and functional status. Cost-effectiveness was analyzed using the incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups showed similar improvements in clinical outcomes, with no significant differences in IKDC scores, pain levels, or range of motion at 12\u00a0weeks. However, TELE rehabilitation was significantly less expensive, with a total cost of 58,303.18 CNY compared to 82,358.90 CNY for FTF (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The ICER analysis demonstrated that TELE was a cost-effective alternative, with substantial cost savings per unit of effectiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Telerehabilitation may be a cost-effective and clinically comparable alternative to traditional face-to-face rehabilitation following ACL reconstruction. These findings may support the broader implementation of TELE in regions with limited access to in-person rehabilitation, especially in low- and middle-income countries like China. Further studies with longer follow-up periods are needed to confirm the long-term cost-effectiveness and health benefits of TELE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      Chinese Clinical Trial Registry (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.chictr.org.cn\/\" ext-link-type=\"uri\">https:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      ). Trial registration ChiCTR2100053313.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13018-025-06403-w","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:55:22Z","timestamp":1766573722000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The efficacy and cost-effectiveness analysis of telerehabilitation for patients after arthroscopic ACL-reconstruction: a non-inferiority randomized controlled trial"],"prefix":"10.1186","volume":"20","clinical-trial-number":[{"clinical-trial-number":"chictr2100053313","registry":"10.18810\/chictr"}],"author":[{"given":"Chenrui","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiqi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaohua","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengdi","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"6403_CR1","doi-asserted-by":"publisher","first-page":"2363","DOI":"10.1177\/0363546514542796","volume":"42","author":"NA Mall","year":"2014","unstructured":"Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363\u201370.","journal-title":"Am J Sports Med"},{"key":"6403_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.csm.2016.08.001","volume":"36","author":"CC Kaeding","year":"2017","unstructured":"Kaeding CC, Leger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med. 2017;36:1\u20138.","journal-title":"Clin Sports Med"},{"key":"6403_CR3","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.1056\/NEJMcp1805931","volume":"380","author":"V Musahl","year":"2019","unstructured":"Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med. 2019;380:2341\u20138.","journal-title":"N Engl J Med"},{"key":"6403_CR4","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/03635465010290030201","volume":"29","author":"AF Anderson","year":"2001","unstructured":"Anderson AF, Snyder RB, Lipscomb AB Jr. Anterior cruciate ligament reconstruction. a prospective randomized study of three surgical methods. Am J Sports Med. 2001;29:272\u20139.","journal-title":"Am J Sports Med"},{"key":"6403_CR5","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00167-016-4275-y","volume":"25","author":"TL Sanders","year":"2017","unstructured":"Sanders TL, Pareek A, Hewett TE, et al. Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc: Of J ESSKA. 2017;25:222\u20138.","journal-title":"Knee Surg Sports Traumatol Arthrosc: Of J ESSKA"},{"key":"6403_CR6","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s00337-023-00953-y","volume":"61","author":"R Tedeschi","year":"2023","unstructured":"Tedeschi R, Giorgi F. What is known about the RegentK regenerative treatment for ruptured anterior cruciate ligament? A scoping review. Man Med. 2023;61:181\u20137.","journal-title":"Man Med"},{"issue":"8","key":"6403_CR7","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1177\/1357633X17723368","volume":"24","author":"K Azma","year":"2018","unstructured":"Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial. J Telemed Telecare. 2018;24(8):560\u20135.","journal-title":"J Telemed Telecare"},{"issue":"2","key":"6403_CR8","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.pmr.2018.12.002","volume":"30","author":"MD Galea","year":"2019","unstructured":"Galea MD. Telemedicine in rehabilitation. Phys Med Rehabil Clin N Am. 2019;30(2):473\u201383.","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"5","key":"6403_CR9","doi-asserted-by":"publisher","first-page":"e18250","DOI":"10.2196\/18250","volume":"22","author":"JF Bailey","year":"2020","unstructured":"Bailey JF, Agarwal V, Zheng P, Smuck M, Fredericson M, Kennedy DJ, et al. Digital care for chronic musculoskeletal pain: 10,000 participant longitudinal cohort study. J Med Internet Res. 2020;22(5):e18250.","journal-title":"J Med Internet Res"},{"key":"6403_CR10","doi-asserted-by":"publisher","first-page":"205520762412861","DOI":"10.1177\/20552076241286186","volume":"10","author":"R Tedeschi","year":"2024","unstructured":"Tedeschi R, Platano D, Pillastrini P, Berti L, Benedetti MG. Effectiveness of tele-rehabilitation in patients with knee osteoarthritis: a randomized controlled trial. Digit Health. 2024;10:20552076241286184.","journal-title":"Digit Health"},{"issue":"7","key":"6403_CR11","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1007\/s00586-010-1676-3","volume":"20","author":"CC Lin","year":"2011","unstructured":"Lin CC, Haas M, Maher CG, Machado LA, van Tulder MW. Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. Eur Spine J. 2011;20(7):1024\u201338.","journal-title":"Eur Spine J"},{"issue":"11","key":"6403_CR12","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1002\/acr.21737","volume":"64","author":"VC Oliveira","year":"2012","unstructured":"Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care Res (Hoboken). 2012;64(11):1739\u201348.","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"6403_CR13","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1177\/03635465010290051301","volume":"29","author":"JJ Irrgang","year":"2001","unstructured":"Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International knee documentation committee subjective knee form. Am J Sports Med. 2001;29:600\u201313.","journal-title":"Am J Sports Med"},{"key":"6403_CR14","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/j.arthro.2007.02.005","volume":"23","author":"K Crawford","year":"2007","unstructured":"Crawford K, Briggs KK, Rodkey WG, et al. Reliability, validity, and responsiveness of the IKDC score for meniscus injuries of the knee. Arthrosc: J Arthrosc Relat Surg. 2007;23:839\u201344.","journal-title":"Arthrosc: J Arthrosc Relat Surg"},{"issue":"6","key":"6403_CR15","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1177\/0363546514524698","volume":"42","author":"VA van de Graaf","year":"2014","unstructured":"van de Graaf VA, Wolterbeek N, Scholtes VA, et al. Reliability and validity of the IKDC, KOOS, and WOMAC for patients with meniscal injuries. Am J Sports Med. 2014;42(6):1408\u201316.","journal-title":"Am J Sports Med"},{"issue":"1","key":"6403_CR16","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/135581969700200105","volume":"2","author":"C Jenkinson","year":"1997","unstructured":"Jenkinson C, Layte R. Development and testing of the UK SF-12 (short form health survey). J Health Serv Res Policy. 1997;2(1):14\u20138.","journal-title":"J Health Serv Res Policy"},{"issue":"3","key":"6403_CR17","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","volume":"34","author":"J Ware Jr.","year":"1996","unstructured":"Ware J Jr., Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220\u201333.","journal-title":"Med Care"},{"issue":"4","key":"6403_CR18","first-page":"885","volume":"35","author":"JN Burdine","year":"2000","unstructured":"Burdine JN, Felix MR, Abel AL, et al. The SF-12 as a population health measure: an exploratory examination of potential for application. Health Serv Res. 2000;35(4):885\u2013904.","journal-title":"Health Serv Res"},{"issue":"1","key":"6403_CR19","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.psychres.2006.11.005","volume":"152","author":"SC Gill","year":"2007","unstructured":"Gill SC, Butterworth P, Rodgers B, et al. Validity of the mental health component scale of the 12-item short-form health survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Res. 2007;152(1):63\u201371.","journal-title":"Psychiatry Res"},{"key":"6403_CR20","unstructured":"Ware JE, Kosinski MA, Keller SD. SF-12: How to score the SF-12 physical and mental health summary scales. 2002."},{"key":"6403_CR21","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.jval.2015.05.009","volume":"18","author":"C Bouwmans","year":"2015","unstructured":"Bouwmans C, Krol M, Severens H, et al. The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses. Value Health. 2015;18:753\u20138.","journal-title":"Value Health"},{"key":"6403_CR22","unstructured":"Circular of the Shanghai Municipal Bureau of human resources and social security on the average wages of employed persons in full-caliber urban units in the city in 2022. Available: https:\/\/rsj.sh.gov.cn\/."},{"key":"6403_CR23","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1093\/ptj\/pzx021","volume":"97","author":"RS Hinman","year":"2017","unstructured":"Hinman RS, Lawford BJ, Campbell PK, Briggs AM, Gale J, Bills C, et al. Telephone-delivered exercise advice and behavior change support by physical therapists for people with knee osteoarthritis: protocol for the telecare randomized controlled trial. Phys Ther. 2017;97:524\u201336.","journal-title":"Phys Ther"},{"issue":"3","key":"6403_CR24","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.arthro.2022.10.014","volume":"39","author":"L Giordano","year":"2023","unstructured":"Giordano L, Maffulli N, Carimati G, et al. Increased time to surgery after anterior cruciate ligament tear in female patients results in greater risk of medial meniscus tear: a study of 489 female patients. Arthroscopy. 2023;39(3):613\u201322.","journal-title":"Arthroscopy"},{"issue":"9","key":"6403_CR25","doi-asserted-by":"publisher","first-page":"2524","DOI":"10.1016\/j.arthro.2018.06.017","volume":"34","author":"N Maffulli","year":"2018","unstructured":"Maffulli N. The early versus late anterior cruciate ligament reconstruction debate: history teaches us that we cannot use reason and evidence to fight and win against conviction. Arthroscopy. 2018;34(9):2524\u20135.","journal-title":"Arthroscopy"},{"issue":"2","key":"6403_CR26","doi-asserted-by":"publisher","first-page":"294","DOI":"10.3390\/medicina61020294","volume":"61","author":"F Migliorini","year":"2025","unstructured":"Migliorini F, Lucenti L, Mok YR, et al. Anterior cruciate ligament reconstruction using lateral extra-articular procedures: a systematic review. Medicina (Kaunas). 2025;61(2):294.","journal-title":"Medicina (Kaunas)"},{"issue":"2","key":"6403_CR27","doi-asserted-by":"publisher","first-page":"252","DOI":"10.32098\/mltj.02.2023.08","volume":"13","author":"S Agrawal","year":"2023","unstructured":"Agrawal S, Hegde AS, Rao BS, et al. Peroneus longus tendon autograft for primary arthroscopic reconstruction of the anterior cruciate ligament. Muscles Ligaments Tendons J. 2023;13(2):252\u20138.","journal-title":"Muscles Ligaments Tendons J"},{"issue":"3","key":"6403_CR28","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.jisako.2022.10.001","volume":"8","author":"SR Piedade","year":"2023","unstructured":"Piedade SR, Leite Arruda BP, de Vasconcelos RA, et al. Rehabilitation following surgical reconstruction for anterior cruciate ligament insufficiency: what has changed since the 1960s? State of the art. J ISAKOS. 2023;8(3):153\u201362.","journal-title":"J ISAKOS"},{"issue":"1","key":"6403_CR29","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1177\/03635465020300011301","volume":"30","author":"MJ Rossi","year":"2002","unstructured":"Rossi MJ, Lubowitz JH, Guttmann D. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2002;30(1):152.","journal-title":"Am J Sports Med"},{"issue":"3","key":"6403_CR30","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s00264-014-2513-9","volume":"39","author":"R Papalia","year":"2015","unstructured":"Papalia R, Franceschi F, Te Cambe A, et al. Anterior cruciate ligament reconstruction and return to sport activity: postural control as the key to success. Int Orthop. 2015;39(3):527\u201334.","journal-title":"Int Orthop"},{"issue":"6","key":"6403_CR31","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1258\/jtt.2010.006005","volume":"16","author":"SM Kosterink","year":"2010","unstructured":"Kosterink SM, Huisin\u2019t Veld RM, Cagnie B, et al. The clinical effectiveness of a myofeedback-based teletreatment service in patients with nonspecific neck and shoulder pain: a randomized controlled trial. J Telemed Telecare. 2010;16(6):316\u201321.","journal-title":"J Telemed Telecare"},{"issue":"2","key":"6403_CR32","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000511228","volume":"30","author":"G Kakavas","year":"2021","unstructured":"Kakavas G, Malliaropoulos N, Bikos G, et al. Periodization in anterior cruciate ligament rehabilitation: a novel framework. Med Princ Pract. 2021;30(2):101\u20138.","journal-title":"Med Princ Pract"},{"issue":"51","key":"6403_CR33","doi-asserted-by":"publisher","first-page":"e36764","DOI":"10.1097\/MD.0000000000036764","volume":"102","author":"H Zhang","year":"2023","unstructured":"Zhang H, Wang J, Jiang Z, et al. Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore). 2023;102(51):e36764.","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"6403_CR34","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1186\/s13018-023-04160-2","volume":"18","author":"B Zhao","year":"2023","unstructured":"Zhao B, Liu H, Du K, et al. Effectiveness and safety of outpatient rehabilitation versus home-based rehabilitation after knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):704.","journal-title":"J Orthop Surg Res"},{"issue":"6","key":"6403_CR35","doi-asserted-by":"publisher","first-page":"468","DOI":"10.2519\/jospt.2009.2971","volume":"39","author":"TS Yeung","year":"2009","unstructured":"Yeung TS, Wessel J, Stratford P, et al. Reliability, validity, and responsiveness of the Lower Extremity Functional Scale for inpatients of an orthopaedic rehabilitation ward. J Orthop Sports Phys Ther. 2009;39(6):468\u201377.","journal-title":"J Orthop Sports Phys Ther"},{"issue":"4","key":"6403_CR36","first-page":"371","volume":"79","author":"JM Binkley","year":"1999","unstructured":"Binkley JM, Stratford PW, Lott SA, et al. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther. 1999;79(4):371\u201383.","journal-title":"Phys Ther"},{"issue":"1","key":"6403_CR37","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1186\/s13018-023-03996-y","volume":"18","author":"M Jebreen","year":"2023","unstructured":"Jebreen M, Maffulli N, Migliorini F, et al. Known-group validity of passive knee joint position sense: a comparison between individuals with unilateral anterior cruciate ligament reconstruction and healthy controls. J Orthop Surg Res. 2023;18(1):525.","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"6403_CR38","doi-asserted-by":"publisher","first-page":"499","DOI":"10.32098\/mltj.03.2024.13","volume":"14","author":"T Lemos","year":"2024","unstructured":"Lemos T, Albarello JCS, Silva SC, Mozella AP. Quadriceps force fluctuation during maximal isometric contraction is altered in ACL injury and is associated with lower limb functional performance: a cross-sectional study with athletes. Muscles Ligaments Tendons J. 2024;14(3):499\u2013506.","journal-title":"Muscles Ligaments Tendons J"},{"issue":"3","key":"6403_CR39","doi-asserted-by":"publisher","first-page":"421","DOI":"10.32098\/mltj.03.2023.10","volume":"13","author":"G Pipino","year":"2023","unstructured":"Pipino G, Tomasi E, Mardones R, et al. Rehabilitation after anterior cruciate ligament reconstruction: dry land vs aquatic rehabilitation. Muscles Ligaments Tendons J. 2023;13(3):421\u20139.","journal-title":"Muscles Ligaments Tendons J"},{"issue":"11","key":"6403_CR40","doi-asserted-by":"publisher","first-page":"NP64","DOI":"10.1177\/0363546519863310","volume":"47","author":"N Maffulli","year":"2019","unstructured":"Maffulli N, Oliva F. Coper classification early after ACL rupture changes with progressive neuromuscular and strength training and is associated with 2-year success: letter to the editor. Am J Sports Med. 2019;47(11):NP64\u20135.","journal-title":"Am J Sports Med"},{"issue":"3","key":"6403_CR41","doi-asserted-by":"publisher","first-page":"450","DOI":"10.32098\/mltj.03.2024.08","volume":"14","author":"JCS Albarello","year":"2024","unstructured":"Albarello JCS, Laett CT, Soares de Palma AM, et al. Associated ACL reconstruction and meniscal repair do not affect the evolution of isokinetic parameters in professional athletes: a prospective study with a one-year follow-up. Muscles Ligaments Tendons J. 2024;14(3):450\u20137.","journal-title":"Muscles Ligaments Tendons J."},{"issue":"5","key":"6403_CR42","first-page":"643","volume":"74","author":"S Ramjug","year":"2008","unstructured":"Ramjug S, Ghosh S, Walley G, Maffulli N. Isolated anterior cruciate ligament deficiency, knee scores and function. Acta Orthop Belg. 2008;74(5):643\u201351.","journal-title":"Acta Orthop Belg"},{"issue":"1","key":"6403_CR43","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/s40634-022-00538-z","volume":"9","author":"CK Hong","year":"2022","unstructured":"Hong CK, Liu ZW, Hsu KL, et al. A novel home-based rehabilitative knee brace system is a viable option for postoperative rehabilitation after anterior cruciate ligament reconstruction: a report of 15 cases. J Exp Orthop. 2022;9(1):96.","journal-title":"J Exp Orthop"},{"issue":"3","key":"6403_CR44","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s43465-020-00045-2","volume":"54","author":"G Kakavas","year":"2020","unstructured":"Kakavas G, Malliaropoulos N, Pruna R, et al. Neuroplasticity and anterior cruciate ligament injury. Indian J Orthop. 2020;54(3):275\u201380.","journal-title":"Indian J Orthop"},{"issue":"3","key":"6403_CR45","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1177\/03635465980260021801","volume":"32","author":"N Maffulli","year":"1998","unstructured":"Maffulli N, King JB. Anterior cruciate ligament injury. Br J Sports Med. 1998;32(3):266.","journal-title":"Br J Sports Med"},{"issue":"2","key":"6403_CR46","doi-asserted-by":"publisher","first-page":"e11330","DOI":"10.2196\/11330","volume":"21","author":"A Buvik","year":"2019","unstructured":"Buvik A, Bergmo TS, Bugge E, et al. Cost-effectiveness of telemedicine in remote orthopedic consultations: randomized controlled trial. J Med Internet Res. 2019;21(2):e11330.","journal-title":"J Med Internet Res"},{"issue":"2","key":"6403_CR47","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.2196\/jmir.3402","volume":"17","author":"M Tousignant","year":"2015","unstructured":"Tousignant M, Moffet H, Boissy P, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. J Med Internet Res. 2015;17(2):e38.","journal-title":"J Med Internet Res"},{"issue":"21","key":"6403_CR48","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.2106\/JBJS.19.00987","volume":"101","author":"JA Browne","year":"2019","unstructured":"Browne JA, Bedard NA, Buchanan MR, et al. After unilateral total knee arthroplasty, unsupervised home exercise programs were noninferior to outpatient physiotherapy for increasing passive knee flexion: a prospective cohort study. J Bone Joint Surg Am. 2019;101(21):2063\u201373.","journal-title":"J Bone Joint Surg Am"},{"issue":"5\u20136","key":"6403_CR49","first-page":"1","volume":"22","author":"MA Cottrell","year":"2017","unstructured":"Cottrell MA, Galea OA, O\u2019Leary SP, et al. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Phys Ther Rev. 2017;22(5\u20136):1\u201324.","journal-title":"Phys Ther Rev"},{"issue":"9","key":"6403_CR50","first-page":"529","volume":"27","author":"Q Li","year":"2021","unstructured":"Li Q, et al. Tele-rehabilitation in developing countries: a review. J Telemed Telecare. 2021;27(9):529\u201337.","journal-title":"J Telemed Telecare"},{"issue":"4","key":"6403_CR51","first-page":"543","volume":"26","author":"KL Wong","year":"2020","unstructured":"Wong KL, et al. Patient acceptance of mobile health technology for rehabilitation. Telemed J E Health. 2020;26(4):543\u201351.","journal-title":"Telemed J E Health"},{"issue":"2","key":"6403_CR52","doi-asserted-by":"publisher","first-page":"902","DOI":"10.3928\/01477447-20130122-02","volume":"36","author":"N Maffulli","year":"2013","unstructured":"Maffulli N, Osti L. ACL stability, function, and arthritis: what have we been missing? Orthopedics. 2013;36(2):902.","journal-title":"Orthopedics"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-025-06403-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-025-06403-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-025-06403-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:02:50Z","timestamp":1766577770000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13018-025-06403-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6403"],"URL":"https:\/\/doi.org\/10.1186\/s13018-025-06403-w","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7565766\/v1","asserted-by":"object"}]},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,24]]},"assertion":[{"value":"8 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of Shanghai Sixth People\u2019s Hospital (Approval No: 2022\u2013045-(1)) on May 26, 2022. All participants provided written informed consent prior to enrolment in the study. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. This study was conducted in accordance with the Declaration of Helsinki, and all participants provided written informed consent prior to enrollment. The consent form explained the purpose of the study, the procedures involved, any potential risks or discomforts, and the voluntary nature of participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors have obtained written informed consent to publish but the written consent itself should be held by the authors themselves.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declared no potential conflicts of interest with respect to the research, authorship, and\/or publication of this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1085"}}