This article is more than 5 years old. Information may no longer be current.
Extended preoperative rehabilitation before ACL reconstruction improved return-to-sport rates
Although preoperative rehabilitation is beneficial, more research is needed to define the optimal preoperative rehabilitation.
Click Here to Manage Email Alerts
Patients treated with additional preoperative rehabilitation consisting of progressive strengthening and neuromuscular training prior to ACL reconstruction experienced greater functional outcomes and return-to-sport rates at 2-year follow-up, according to study results.
“Our research suggests that this additional preoperative rehabilitation beyond what the current standard in orthopedics has the potential to influence outcomes 2 years after ACL reconstruction,” Mathew J. Failla, PT, MSPT, SCS, assistant professor in the Department of Rehabilitation and Movement Science at the University of Vermont, told Orthopedics Today.
Preoperative rehabilitation
Failla and his colleagues compared outcomes of 192 patients from the Delaware-Oslo ACL Cohort who underwent an extended preoperative rehabilitation, which included neuromuscular training, prior to ACL reconstruction with 1,995 patients from the Multicenter Orthopaedic Outcomes Network who did not undergo extended preoperative rehabilitation. Researchers collected preoperative and 2-year postoperative IKDC subjective knee score and KOOS and calculated return-to-sport rates for each cohort at 2 years.
Results showed significant and clinically meaningful differences in IKDC and KOOS scores 2-years after ACL reconstruction among patients who underwent extended preoperative rehabilitation after adjusting for baseline IKDC and KOOS scores. Researchers noted 72% of patients who underwent extended preoperative rehabilitation returned to pre-injury sports compared with 63% of patients who did not undergo extended preoperative rehabilitation.
“The current standard to undergo reconstruction is to allow the patient’s knee to become a quiet knee, which means the patient has regained full range of motion, they have little to no joint effusion and they have regained at least some sort of a basic quadriceps contraction,” Failla said. “Our data shows if we went beyond by 10 visits [and do not] delay surgery more than 4 weeks to 6 weeks, we are able to improve outcomes.”
He continued, “We have this bias that rehabilitation after surgery is more important than what happens before surgery, but we do not truly know that. I am not saying postoperative rehabilitation is not important, but our data shows we can also affect outcomes with preoperative as well. That is the kind of an untapped window that we have not looked into yet to try to improve outcomes after ACL reconstruction.”
Limitations
Despite the evidence from this study that shows preoperative rehabilitation is beneficial to patients, Failla noted the study was unable to define the optimal preoperative rehabilitation.
“There is insurmountable evidence showing how important range of motion and limited joint effusion and quadriceps muscle strength is to the knee joint. It is reasonable to maximize that as much as you can before you undergo an extended period of unloading or limited physical activity; it makes sense that [leads] to better outcomes down the road,” Failla said. – by Casey Tingle
- Reference:
- Failla MJ, et al. Am J Sports Med. 2016;doi:10.1177/0363546516652594.
- For more information:
- Mathew J. Failla, PT, MSPT, SCS, can be reached at the University of Vermont, Burlington, VT 05405; email: mathew.failla@med.uvm.edu.
Disclosures: The study was funded by the National Institutes of Health. Failla reports no relevant financial disclosures.