Research has shown that pre-operative physical therapy or “Prehab” can improve post-operative outcomes for patients undergoing anterior cruciate ligament (ACL) reconstruction surgery.
Clinically, we see all the time the benefits of pre-operative physical therapy on post-operative outcomes. This is true for a variety of orthopedic conditions – from total joint arthroplasty to tendon and ligament repairs. And the benefits are particularly strong for patients with ACL repairs.
When it comes to ACL reconstruction, the return-to-sport statistics can be sobering. Athletes who return to sport post ACL reconstruction are at increased risk of reinjury. A proportion are unable to return to sport at their pre-injury levels at all.
Because of this, many clinicians and researchers are working at ways to optimize the surgical and rehabilitation process for the best possible outcomes.
In most cases, pre-habilitation is quite simple. The physical therapist’s goals often are to reduce a patient’s swelling, restore range of motion and flexibility and maintain strength in the walkup to surgery.
This ensures that the injured area is as “clean” and “normal” and ready for surgery as possible. The hope is that this will make the surgery as smooth-going as possible. It will also streamline the post-operative process. Restoring range of motion prior to surgery will make the process of maintaining range of motion post operatively all the easier.
In 2020, Florian Giesche et al conducted a systematic review of the effects of prehabilitation before ACL-reconstruction on return to sport. Their review scoured over 1,000 studies and trials. In some cases, they found patients who underwent prehabilitation reported clinically significant higher levels of knee function than controls at the 2-year post op mark.
Their review overall found improved neuromuscular function and overall self-reported knee function among patients who received prehabilitation when compared to controls.(1)
In the cases reviewed physical therapy entailed such interventions as leg strengthening, balance, stability and proprioceptive training, focus on activation of the quadriceps muscles, stretching, range of motion exercises, joint mobilizations, and at times application of kinesiology tape.
FAQs
Here are some answers to commonly asked questions:
I tore my ACL and have scheduled surgery for 6 months from now. When should I have physical therapy?
Talk with your surgeon about the appropriate time to begin physical therapy. Physical therapy can begin at any time determined by your surgeon. It can begin months before surgery date or in the immediate walkup to surgery.
How long with prehabilitation last?
The average length of prehabilitation for ACL reconstruction is 4-6 weeks. But, in some cases, it can be a few as 3-4 visits.
How should I prepare for physical therapy?
All we ask is that you wear comfortable clothing, such as shorts that enables the physical therapist to examine the knee, treat as needed and also see how the knee is moving as you perform exercises. For further guidance, contact the clinic directly.
I tore my ACL, but my doctor has not mentioned prehabilitation. What should I do?
Contact your surgeon to discuss whether prehabilitation is right for you. If you have further questions, Sun Physical Therapy offers free phone or in-person consultations. These are casual, 15-minute conversations in which you can discuss your case with a licensed physical therapist, ask any questions you may have and discuss treatment options.
I have an orthopedic injury other than an ACL tear. Is prehabilitation right for me?
In many cases, prehabilitation is an excellent way to prepare for a surgery. Prehabilitation can be beneficial prior to such surgeries as joint replacements, ligament and tendon repairs, spinal surgeries, even cosmetic surgery. We recommend discussing your option directly with your surgeon. And, again, we offer free consultations if you wish to discuss the specifics of your injury and treatment options.
Sources
(1) Gieschel, Florian, Daniel Niederer, Winfried Banzer, and Lutz Vogt. Evidence for the effects of prehabilitation before ACL-reconstruction on return to sportrelated and self-reported knee function: A systematic review. PLoS One. 2020; 15(10): e0240192. Published online 2020 Oct 28. doi: 10.1371/journal.pone.0240192
