Do athletes benefit from preoperative physical therapy before ACL-reconstruction?

Gränicher, Pascale; Scherr, Johannes

doi:10.1016/j.orthtr.2021.04.038

Cited by 6 publications

(8 citation statements)

References 34 publications

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“…To date, there is no consensus on the optimal timing of surgical reconstruction [ 27 , 28 ]. Some authors advocate awaiting the end of the inflammatory phase, which is supposed to end around 3–6 weeks post-injury.…”

Section: Discussionmentioning

confidence: 99%

Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases

Mauch

Heitner³

et al. 2023

Arch Orthop Trauma Surg

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Introduction The recovery of periarticular strength is a major criterion in return-to-play testing. The rationale of the study was to assess the impact of the delay of surgery (∆ between injury and surgery) on knee extensor and knee flexor strength of anterior cruciate ligament (ACL)-deficient patients six months after reconstruction. Materials and methods In a retrospective cohort study, all patients with ACL ruptures between 03/2015 and 12/2019 were analyzed. Inclusion criteria were isolated ACL rupture without any associated lesions undergoing a reconstruction using ipsilateral hamstring tendon autograft and adherence to isokinetic strength testing before and at 5–7 months postoperatively. These patients were then clustered into three groups: EARLY reconstruction (∆ < 42 days), DELAYED reconstruction (∆42-180d), and CHRONIC (∆ > 180d). Knee extensor and flexor strength of the ipsi- and contralateral leg were analyzed by concentric isokinetic measurement (60°/s). Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q) ratio), and the corresponding limb symmetry indices. Results n = 444 patients met the inclusion criteria. From EARLY to DELAYED to CHRONIC, a progressive reduction in postoperative strength performance was observed in knee extension (1.65 ± 0.45 to 1.62 ± 0.52 to 1.51 ± 0.5 Nm/kg resp.) and flexion (1.22 ± 0.29 to 1.18 ± 0.3 to 1.13 ± 0.31 Nm/kg resp.) strength on the ACL reconstructed leg. This general loss in periarticular strength was already apparent in the preoperative performance even on the healthy side. When controlling for the preoperative performance using ANCOVA analysis, EARLY performed significantly better than DELAYED (extension p = 0.001, flexion p = .02) and CHRONIC (extension p = 0.005, flexion p < 0.001). Also, there were significantly higher values for H/Q ratio in the injured leg across all groups where the H/Q ratio increased from EARLY to CHRONIC and from pre- to postoperative values. Conclusions With respect to the force generating capacity when returning-to-play, it is advantageous to seek for an early ACL reconstruction within the first 12 weeks after the injury. The increasing loss of thigh muscle strength observed in delayed or chronic cases affects the injured and also the non-injured leg. Level of Evidence III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases

Mauch

Heitner³

et al. 2023

Arch Orthop Trauma Surg

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“…Whilst this is an underdocumented area of research, there are some studies which address strategies used to reduce the risk of kinesiophobia limiting post-operative functional outcomes. Supporting patients pre-ACLR both physically and psychologically can address risk factors like kinesiophobia and improve outcomes [59] . Prehabilitation may help reduce the asymmetries in quadriceps strength post-operatively [43,59] .…”

Section: Discussionmentioning

confidence: 99%

“…Supporting patients pre-ACLR both physically and psychologically can address risk factors like kinesiophobia and improve outcomes [59] . Prehabilitation may help reduce the asymmetries in quadriceps strength post-operatively [43,59] . Another review found that some studies showed the benefits of using motor imagery to improve clinical outcomes, although further research is needed in this area [60,61] .…”

Section: Discussionmentioning

confidence: 99%

The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review

Marok

Soundy

2021

Disability and Rehabilitation

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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“…The significance of preoperative physiotherapy management (prehabilitation) prior to ACLR surgery cannot be questioned. In the orthopaedic field, the concept of prehabilitation has gained attention as it has been found to improve the outcome following surgery (Gränicher & Scherr, 2021). The benefits of prehabilitation has been explained previously (Giesche et al, 2020;Gränicher & Scherr, 2021) and comprises reduced post-operative pain, length of stay in the hospital, and post-operative complications, while it increases knee functions and have early return to sports rate.…”

Section: Discussionmentioning

confidence: 99%

“…In the orthopaedic field, the concept of prehabilitation has gained attention as it has been found to improve the outcome following surgery (Gränicher & Scherr, 2021). The benefits of prehabilitation has been explained previously (Giesche et al, 2020;Gränicher & Scherr, 2021) and comprises reduced post-operative pain, length of stay in the hospital, and post-operative complications, while it increases knee functions and have early return to sports rate. Better ACLR rehabilitation results can be attained by a struc-tured preoperative physiotherapy management (Grindem et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Pattern of Anterior Cruciate Ligament Reconstruction (ACLR) among Athletes in Malaysia between 2015 and 2020

Zainudin

Ibrahim

Nadzalan

et al. 2022

Teor. metod. fiz. vihov.

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Background. Individual involvement in sports activity is rising and thus increases the risk of knee injury. Anterior Cruciate Ligament (ACL) rupture is the most common knee injury requiring ACL reconstruction (ACLR). However, limited evidence is available to date on ACLR characteristics in Malaysia for comparison with Western countries. This study aims to describe the epidemiological characteristic of ACLR surgery and the trend of pre-operative physiotherapy (pre-habilitation). Materials and methods. ACLR cases recorded in a tertiary hospital database between January 2015 and December 2020 were extracted and reviewed. This retrospective study was approved by the hospital’s Research Ethics Committee (UKMPPI/111/8/JEP-2020-500). All ACLR cases involving sports injuries were included with the exclusion of non-sports related injuries. Yearly ACLR cases were retrieved using an Injury Information form containing variables namely age, gender, type of ACL tear, accompanying meniscus injury, duration from injury to surgery and pre-habilitation details. Descriptive statistics were used to summarize the sample data. Results. A total of 131 ACLR cases were reported between 2015 and2020 (Male, n =122; Female, n = 25). The number of ACLR cases fluctuated during the observed years, with a maximum of 30 cases reported in a year and 98% of the cases were represented by the youth age group (15 – 47 years old). The average age at time of surgery was 27.1 (± 7.79). On an average, 80% of athletes stated no history of previous knee injury. The most common type of ACL injury was a complete tear (88%), followed by partial tear (9%), and re-rupture (3%). A meniscus injury was noted in 61% of cases. The time from injury to surgery was 15 weeks. The study found low percentage of the ACLR patients who received pre-habilitation prior to surgery (<20%). Conclusions. ACLR cases are showing a fluctuating trend every year. Despite the majority of the ACL cases being a complete tear, the participants waited more than four months to undergo ACLR, with only a quarter of them had pre-habilitation prior to surgery. The reasons for these situations require investigation. Future research inclusive of a larger database is also desirable to develop a better insight into ACL injury pattern.

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Do athletes benefit from preoperative physical therapy before ACL-reconstruction?

Cited by 6 publications

References 34 publications

Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases

Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases

The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review

Pattern of Anterior Cruciate Ligament Reconstruction (ACLR) among Athletes in Malaysia between 2015 and 2020

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