Tearing your ACL is one of the most traumatic events an athlete can suffer. For active people, surgery is recommended to stabilize the knee and optimize the health of the knee decades later. We have seen good – but maybe not great – rates of return to pre-injury sports and exercise.
Roughly 175,000 ACL reconstructions are performed each year in the United States. Generally, all patients undergo a progressive rehabilitation with physical therapy to restore function after surgery. One of the most debated questions regarding ACL surgery revolves around whether rehab before surgery can improve outcomes.
What is prehabilitation?
Generally speaking, prehabilitation prepares the patient for periods of immobilization and inactivity after surgery. For ACL surgeries, prehab focuses on strengthening of the lower extremity muscles and neuromuscular training.
Is prehab effective for ACL surgery?
Authors of a recent study aimed to determine if a short course of strengthening and neuromuscular training before ACL reconstruction improved patient satisfaction, function and return to sports two years after surgery. One group of active patients used the traditional means of preparing for surgery – decreasing knee swelling and increasing range of motion. The other group also worked to achieve motion and swelling goals but also performed 10 sessions of neuromuscular training.
The differences between groups was significant. The group of patients who performed preoperative rehab had higher patient-reported function two years after surgery. They were also much more likely to be playing their preinjury sport two years after ACL surgery.
The authors could not determine which strengthening exercises or which parts of neuromuscular work were most helpful. They could determine, though, that the patients who performed prehab had better long-term outcomes than patients who only worked to decrease swelling, make their quads fire, regain knee motion and decrease pain.
Take home message
Clearly there seems to be great benefit to a course of preoperative physical therapy for ACL reconstruction surgery. We need to do more than help the patient get his or her knee calmed down before surgery.
In the current healthcare climate in United States, orthopedic surgeons and physical therapists are finding patients paying larger amounts of money out-of-pocket or having their total number of physical therapy visits each year cut. With more evidence that a course of prehab can improve outcomes, surgeons and therapists should consider insisting that these programs become standard of care for active patients facing ACL surgery.
Have you had ACL surgery, or one of your family members had ACL reconstruction? Did you undergo rehab before surgery? If not, do you wish you had? I would love to hear your experience below!
Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L, Huston LJ, Spindler KP, Snyder-Mackler L. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. Am J Sports Med. 2016 Jul 14.