Role of Prehabilitation in Improving Outcomes after Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is a frequent orthopedic problem which commonly leads to knee instability, loss of function, and delay in recovery. Even though ACL reconstruction (ACLR) is a common procedure, there are significant differences in the results that follow the procedure. Recent data indicate that prehabilitation, which is a rehabilitation performed before surgery, can enhance post-operative outcomes; although its use has not been widely incorporated into clinical practice yet.

The objective of the study was to determine the efficacy of structured prehabilitation in enhancing the pain, muscle strength, functional outcomes, range of motion, and early post-operative recovery after ACLR.

A prospective comparative interventional study was done on 50 patients who had primary ACL repair in a tertiary care hospital. The participants were separated into two groups: Group A (n = 25) underwent a structured prehabilitation before surgery, and Group B (n = 25) underwent the usual care that did not involve prehabilitation. Prehabilitation involved strengthening, range-of-motion, balance, proprioception, and patient education. The two groups were subjected to the same post-operative rehabilitation program. Measures of outcomes such as strength of the quadriceps, pain level with the visual analog scale (VAS), knee range of motion, functional outcome scores, time to ambulate independently, and overall post-operative outcome were also evaluated.

The prehabilitation group had better pre-operative quadriceps strength (4.1 ± 0.6 vs. 3.5 ± 0.7) and low pre-operative pain scores (4.2 ± 0.9 vs. 5.1 ± 1.0). During the post-operative period, Group A had a significantly lower pain level at 6 weeks (2.1 ± 0.7 vs. 3.4 ± 0.8) and had a higher knee range of motion (128.5 ± 6.2 vs. 118.3 ± 7.1). The prehabilitation group had more favorable functional outcome scores at 3 months (86.4 ± 5.8 vs. 78.2 ± 6.4). Excellent overall results were more common in the prehabilitation group (72% vs. 40 percent of Group A vs. Group B).

Pre-operative structured prehabilitation before ACLR is an important factor in the management of pain post-operative, functional outcome, muscle strength, and early mobility. Prehabilitation can be implemented as a part of the standard ACLR care to potentially improve the outcomes of the surgery and recovery of patients.