ACL injury, what now? The importance of prehabilitation prior to ACL surgery
Unfortunately, if you have torn your ACL, and are undergoing surgical reconstruction, to return to full function and performance a 9–12-month recovery period is required. Although, this sounds like an extended period, it is necessary to allow for adequate healing as well as to significantly lower your risk of re-injury upon returning to sport.
Everyone will require rehabilitation following surgery, however, there is evidence to indicate the importance of also completing a period of prehabilitation prior to ACL reconstruction. With 9-12 months recovery following surgery only being a guideline, your ACL rehab progression should be criteria based rather than timeline based. Such criteria, which your physiotherapist will regularly assess, include levels of swelling, range of motion, strength, and power.
Following surgery, you will experience pain, swelling, reduced range of motion and therefore muscle loss and atrophy. All these initial negative effects of surgery will bring you further away from meeting your goals and return to function.
This is where prehabilitation can play a vital role in a smooth recovery. The goal of prehabilitation will be to raise the bar on your physical conditioning prior to surgery so therefore the negative effects (such as muscle wasting) following surgery won’t have as big of an impact and you will hopefully be able meet the required rehabilitation criteria quicker.
A study examining the effects of a 12-week prehabilitation period was able to identify these positive effects and compared them to a group who had completed no prehabilitation. The group who participated in prehabilitation reported significantly better functional knee scores at multiple post operative time points – indicating earlier recovery of function. Refer to the graphs which maps improvement of knee function following surgery over a 12-month period between a group who completed prehabilitation and group who did not.
Figure retrieved from: (S. R. Shaarani et al., 2012)
What does prehabilitation involve?
A prehabilitation program will be constructed by your physiotherapist to address deficits which you may have, following your acute knee injury. Common deficits include restricted knee range of motion, asymmetrical gait pattern, muscle wasting of the quadriceps. hamstring and calf.
The aim will be to utilise your program to improve the overall function and stability of your knee prior to surgery. Example treatments and exercises from a prehabilitation program can be seen below.
In addition to improving your preoperative knee condition, being involved with your physiotherapist early will allow you to develop an early post-operative rehabilitation plan. This will help you better understand the goals of early rehabilitation and put at ease any questions or concerns you may have.
References
Abel, R., Niederer, D., Offerhaus, C., Shafizadeh, S., Glowa, A., Froböse, I., & Wilke, C. (2023). Effects of exercise prehabilitation before anterior cruciate ligament reconstruction on functional outcomes during pre- and postoperative rehabilitation – protocol for a single-blinded randomised controlled trial. Trials, 24(1), 752. doi: 10.1186/s13063-023-07776-1
Giesche, F., Niederer, D., Banzer, W., & Vogt, L. (2020). Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review. PloS one, 15(10), e0240192. https://doi.org/10.1371/journal.pone.0240192
Kaplan, Y., & Witvrouw, E. (2019). When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria. Sports health, 11(4), 301–305. https://doi.org/10.1177/1941738119846502
Kyritsis, P., Bahr, R., Landreau, P., Miladi, R., & Witvrouw, E. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British journal of sports medicine, 50(15), 946–951. https://doi.org/10.1136/bjsports-2015-095908
R. Shaarani, N. Moyna, R. Moran, J. M. O’Byrne, “Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review”, International Scholarly Research Notices, vol. 2012, Article ID 938974, 11 pages, 2012. https://doi.org/10.5402/2012/938974