Over 100,000 patients undergo ACL reconstructions every year in the United States. Many of these athletes and active people don’t achieve the results they want, often not being able to play sports or exercise at their desired levels. Significant research has looked at ways to improve our results after these injuries and surgeries. The rehab after surgery clearly plays a large role in a patient’s success.
There are some possible factors that could play a role in patient outcomes. An athlete or active individual may not do any of these components of rehab, and they might still do well. Any of them, though, could help patients have good short- and long-term outcomes.
The patient who pushes herself to overcome knee stiffness, pain and weakness can likely improve her chances of returning to play. Some motivation is patient-dependent, meaning that she has an innate desire to work hard. Often, though, surgeons and physical therapists can help with patient motivation.
Providing thorough education on the nature of the injury, the surgery and the length and nature of the rehab process can be very important. Identifying anxiety and fear of reinjury and taking steps to address them can help. Setting goals can give the patient targets for each phase of rehab and return to sports. Clinicians providing support in these areas can reinforce why postoperative physical therapy is so important.
Orthopedic surgeons have largely focused on decreasing preoperative swelling and knee stiffness. Some surgeons push patients to improve lower extremity strength before surgery. Often they set goals to make the injured leg 90% as strong as the uninjured leg in the quadriceps and hamstring muscles and with single-leg hop tests. Not all patients can achieve these goals, but they could help a patient regain strength and improve function after surgery.
Specialized sports medicine clinic
A recent Norwegian study showed much better patient outcomes one year after ACL reconstruction than did a similar study in Sweden. It is possible that the Norwegian patients did better because they performed their rehabilitation in a specialized sports medicine clinic.
While a patient can certainly do well in smaller orthopedic surgery and physical therapy clinics, it is possible that larger, more comprehensive sports medicine programs have advantages. More education, more ancillary personnel, such as sports psychologists to help with anxiety and fear of reinjury, and physical therapists who specialize in working with athletes could be helpful.
Working with a physical therapist to regain range of motion, quadriceps and hamstring strength and decrease swelling can improve outcomes after surgery. This “prehab” can take 2 to 6 weeks. That short period of time can lead to long-term success. Studies have shown better postoperative knee function, even up to two years out from surgery.
These and other factors are worth discussing with an orthopedic surgeon before ACL surgery to better understand the injury and rehab ahead and possibly increase the chances of returning to a desired level of activity.
Have you done a course of physical therapy before ACL surgery or wish you had? Physical therapists, do you recommend “prehab” before ACL reconstruction? Share your thoughts below!
Grindem H, Risberg MA, Eitzen I. Br J Sports Med. Published online first August 3, 2015.
Hägglund M, Waldén M, Thomeé R. Br J Sports Med. Published online first June 5, 2015.