The effectiveness of a 12 week digital plan for patients recovering after an ACL reconstruction


re.flex – Recovery made simple


Digitizing the musculoskeletal physiotherapy. Reshaping the industry for better clinical outcomes and more transparent reimbursements. Creating the circle of trust where patients, healthcare providers, and payers are all winners.


01 Key data about ACL


  • The anterior cruciate ligament (ACL) is the most vulnerable ligament of the knee (5)
  • The risk of developing knee osteoarthritis increases without a proper recovery (9, 10, 11)
  • Only around 30% of patients are fully compliant and finish their recovery (6)
  • Direct and indirect costs of the physical therapy after ACLR paid by patients can be as high as 5000$
  • re.flex – “Recovery made simple” is the first remote patient monitoring solution that allows physical therapists and orthopedic surgeons to collaborate and design advanced rehabilitation protocols.

Setting a new standard for the digitized physical therapy solutions, re.flex reduces patient’s uncertainty and increases patient motivation to train, thus improving the quality and quantity of training.

Patients using in their recovery re.flex for assisting their physical therapy sessions reported:


re.flex has a 400% ROI for patients by postponing the surgery on the most severe cases of gonarthrosis.

02 A deeper look into the knee injuries

Knee osteoarthritis has doubled in prevalence since the mid-20th century.
The causes of this disease are attributed to multiple factors like age, weight, heredity, repetitive stress injuries or traumatic events, such as a ligament injury. Looking into the epidemiology of knee injuries, ligament injuries had a total of 40% of all related causes. Going further into the data, out of all ligaments of the knee, ACL had a 46% prevalence (1). The most common cause of permanent disability following a sports injury was an injury to the knee. An ACL injury can trigger the knee osteoarthritis if physical therapy is not done right. (9, 10, 11)

In has been shown that patients who achieved satisfactory outcomes with more home-based rehabilitation and a lesser number of supervised physical therapy sessions. (8)

03 Advanced customization of the rehab protocol


Rehabilitation after an ACL reconstruction is a very complex topic because of the lack of data that researchers need in order to understand all aspects of the problem and create better rehabilitation protocols and predictive tests. (7)
ACL tears and sprains are considered sports injuries and most of the research revolves around athletes.

But the entire population has a certain risk to sustain such injuries at some point in their lives, doing only recreational activities (Ski, football, basketball, etc).

With re.flex, outpatient physical therapy clinics are empowered to use an evidence-based approach, gathering patient’s rehabilitation data to optimize the treatment protocols and increase the level of customization that every unique orthopedic patient needs.
Insurance companies are also striving to analyze and understand this data, that helps them optimize the reimbursements processes.





Physical therapy raises a lot of challenges for patients. In order to achieve a full recovery, they need to show a substantial commitment over an extended period of time. And there are a lot of environmental, physical an psychological factors that are influencing the adherence to treatment.

04 Time saved


Patients need to find a way to incorporate physical therapy sessions in their lives. This often means skipping 1-2 hours from work to reach the clinic and do a 40 minutes session of training.

Short term recovery: 2-3 months
Returning to sport: 6-9 months

Using re.flex after ACL reconstruction, patients saved on average 67 hours of traveling during the course of the 12 weeks treatment.

05 Money saved


The physical therapy sessions from public insurance or even the private insurance plans are not always enough to provide patients with their desired medical outcomes. By adding the copayments, extra sessions paid out-of-pocket and transportation expenses, patients are paying in Europe between 1000-5000 Euros.





re.flex reduced the direct costs of treatment with 60% and the indirect costs with 90%.



06 Increased convenience


In order to achieve the required outcomes, patients after ACL reconstruction need to start physical therapy as soon as possible. In some cases, the long waiting lines that the outpatient clinics are having is making the accessing of physical therapy hard. In other cases, it’s the patient who is having a hard time finding the way to the clinic. Traveling in clutches is very hard and family members need to provide support.

95% of patients declared that they are happy with the outcomes and felt safe during the sensors assisted rehabilitation session.

re.flex results from the patient’s perspective

Patients using re.flex showed a better commitment to the rehabilitation plan after ACL reconstruction. We analyzed the data of 40 adult patients from Centrokinetic, a leading physiotherapy clinic in Romania.

07 Increased adherence for patients using re.flex


Quality in-clinical sessions vs. long term physiotherapy on-demand
One physiotherapy session performed in the clinic will always be more effective compared to one session using a digital solution. Having access to all the equipment that the clinic provides, together with the guidance of an experienced physiotherapist, a patient will achieve better results at the end of the session. But in the long term, non-compliance will prevail because the patient needs to return to work, spend time with his family and save money.

On the other hand, the digital solution provides many advantages, because the patient is not limited to 6-10 reimbursed sessions stretched over a 3 month period or having to pay extra sessions out of pocket.
Using a digital solution he can travel less and train more, every day if necessary, and pay less. The increased demand for physical therapy all over the world makes this digital approach convenient and scalable for outpatient clinics.

08 Slightly better Oxford Knee Scores for patients using re.flex at home


Due to the convenience that the treatment with re.flex provides, patients were able to train more and achieve slightly better clinical outcomes than patients recovering in the clinic.
An average difference of 1.3 OKS points was recorded in favor of the intervention group, after 12 weeks of physical therapy. Patients were satisfied with the results using this approach, in terms of improving postoperative quality of life. Delivering treatments with re.flex brings an operational advantage for the outpatient clinics that are using the system.

In order to deliver a month of treatment for a patient, the physiotherapist needs to allocate only 2 hours in total for an initial session, communication and protocol adjustments.
In the following months, the average time invested drops to 1 hour per patient per month.

09 Centrokinetic saved 110 clinical hours using re.flex


In the present study, Centrokinetic worked with groups of 4-10 patients and 60 minutes sessions. Each physiotherapist had an average of 15 minutes allocated to each patient on every 1-hour session.

For clinics delivering 1-on-1 sessions, the time saved increases significantly. These calculations are meant to set a baseline for further implementations.

Dr. Bogdan Andrei

Senior surgeon @ Medlife Hospital
Owner of Centrokinetic Rehabilitation Center
Fellow at University Carol Davila (UMF)
Over 6000 surgeries performed
Specialized in knee surgeries
Author of 500+ orthopedic articles




“I was impressed by the determination that patients have shown throughout the course of the treatment. re.flex motivate them to adhere to the physical therapy plan. And because we were able to track the home adherence and the correctness of the exercises, the distance was no longer a problem. We used the app to communicate with the patients and everything went well. Patients are satisfied with their outcomes, and so as the therapists”, Dr. Bogdan Andrei, Centrokinetic.


10 Conclusions
Without no doubt, one physical therapy session performed in a modern clinical setting is more effective than one at home, using any digital solution. But in the long run, providing patients with convenient sensor assisted physical therapy, reassurance and having the home activity remotely monitored by a physiotherapist through re.flex, has the potential of reducing the costs of treatment and increasing the adherence.
Results of the present study are aimed to set a baseline for further investigations into the right amount of home component (% clinic / % home) that a post-operative rehabilitation plan needs to have, in order for patients to be adherent and the program to produce positive medical outcomes.
Another important aspect to consider is the large number of hypotheses that researchers can formulate and test using the re.flex system, which improves the access to physical therapy pre-op/post-op and an instrument that physiotherapist and orthopedic doctors can use to manage gonarthrosis cases.


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