ACL Pre-Op Rehab

The goal of a pre-surgical rehabilitation program is to maximize knee function prior to surgery to improve the knee function after surgery. Cunha et al. (2022) state in their review “prehabilitation prior to ACL reconstruction may decrease the loss of functional capacity by restoring neuromuscular control, knee strength, knee and joint position sense, while lowering pain levels and psychologically preparing athletes for return to sport at a similar level to preinjury”. Goals include restoring knee motion, strength, and function (Fig 1.) and Nevada Physical Therapy is uniquely trained to help athletes in the Reno-Sparks area that have recently torn their ACL and have elected to pursue surgery meet these goals.

There is an overwhelming amount of scientific literature on anterior cruciate ligament reconstruction techniques, biomechanical effects, protocol recommendations and return to sport outcomes however when we look at pre-surgical rehabilitation, there are far fewer articles. Of those that have been published, there seem to be several themes. First, athletes that completed a pre-surgical rehab (prehabilitation) seemed to do better in a variety of metrics compared to those that went straight to surgery. Specifically, those that completed a prehabilitation plan of care prior to surgery demonstrated 12-15% greater improvement in subjective knee outcome measures compared to those that did not (Failla et al., 2016). Those that completed a prehab program demonstrated improved quad strength and knee function and decreased muscle activity imbalance after surgery compared to the control group (Alshewaier et al., 2017, Ficek et al. 2022) with Grindem et al. reporting a goal of establishing at least a 90% quad strength index compared to the uninjured side prior to surgery (2016). Nevada Physical Therapy is the only sports medicine clinic in Northern Nevada that is able to measure the isometric strength, torque development, power, and function of the quadriceps through our specialized equipment and testing protocol. You can read more about the testing in our Return to Sport Testing breakdown and see why we are the leaders when it comes to data-driven ACL rehabilitation in the Reno-Sparks metro. Improved quad strength prior to surgery was a significant predictor for IKDC2000 scores 6 months after ACL reconstruction and not surprisingly, better quad strength has been correlated with better subjective knee function, knee outcome measures and patient satisfaction (Logerstedt et al., 2013).

Nevada Physical Therapy specializes in both non-surgical ACL injury rehab as well as post-surgical rehabilitation and for over 30 years we have been the Reno- Sparks region’s experts in getting athletes and active individuals back to their prior level of activity. Prehabilitation prior to surgery is only one piece of the rehab puzzle! Yalfani et al. wrote that “preoperative rehabilitation, consisting of progressive strengthening and neuromuscular training, followed by a postoperative rehabilitation program, had greater functional outcomes after ACLR and that preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLr” in their 2021 systematic review.

Sample Prehabilitation Program For Pre-Surgical ACL-injured Patients

References cited:

1. Cunha J, Solomon DJ. ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e65-e69. Doi:

2. Failla MJ, Logerstedt DS, Grindem H, et al. 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;44:2608-2614.10.1016/j.asmr.2021.11.001. PMID: 35141537; PMCID: PMC8811524.

3. Alshewaier, Yeowell, G., & Fatoye, F. (2017). The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. Clinical Rehabilitation, 31(1), 34–44. https://doi.org/10.1177/0269215516628617

4. Ficek, Golas, A., Pietraszewski, P., Strozik, M., & Krzysztofik, M. (2022). The Effects of a Combined Pre- and Post-Operative Anterior Cruciate Ligament Reconstruction Rehabilitation Program on Lower Extremity Muscle Imbalance. Applied Sciences, 12(15), 7411–. https://doi.org/10.3390/app12157411

5. Granicher P, Scherr J. Do athletes benefit from preoperative physical therapy before ACL-reconstruction? Sports Orthopaed Traumatol 2021;37:126-131.

6. Grindem H, Granen LP, Risberg MA, et al. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction two years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Brit J Sports Med 2015;49:385-389

7. Logerstedt, Lynch, A., Axe, M. J., & Snyder-Mackler, L. (2013). Pre-operative quadriceps strength predicts IKDC2000 scores 6 months after anterior cruciate ligament reconstruction. The Knee, 20(3), 208–212. https://doi.org/10.1016/j.knee.2012.07.011

8. Yalfani A, Ebrahimi Atri A, Taghizadeh Kerman M. The effect of prehabilitation on the self-reported outcomes of anterior cruciate ligament reconstruction: A systematic review. Iran J Health Sci 2021;9:45-55.