Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

Abstract

The rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction requires symmetry in bilateral quadriceps strength and adequate proprioception capabilities prior to return to preoperative level of activity or sport. This is the limiting factor and can delay the time that patients can return to play. There is little literature on pre-operative physiotherapy or prehabilitation of patient with ACL injury. This paper discusses the anatomy, biomechanics, surgical decision making, and the current knowledge of preoperative training or "prehabilitation" in patients awaiting ACL reconstruction.

The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review

“…Internal knee injuries account for nearly 45% of sports related injuries, with anterior cruciate ligament injury being the most prevalent structure damaged 1 . Anterior cruciate ligament injury is associated with pain, instability of the joint, muscle weakness, functional limitation, poor quality of life, and an increased risk of knee-related osteoarthritis 2,3 . Anterior cruciate ligament reconstruction surgery is the main treatment for anterior cruciate ligament injuries 4 .…”

“…1 Anterior cruciate ligament injury is associated with pain, instability of the joint, muscle weakness, functional limitation, poor quality of life, and an increased risk of knee-related osteoarthritis. 2,3 Anterior cruciate ligament reconstruction surgery is the main treatment for anterior cruciate ligament injuries. 4 Over 200 thousand anterior cruciate ligament reconstruction surgeries take place each year in the United States, which costs more than $3 billion annually.…”

Prehabilitation Coming of Age

“…A growing number of studies have shown that prehabilitation prior to orthopedic surgery accelerates the return to normal physical function, potentially hastening the capacity to return to work. 20,24,27 Similar to patients with stable coronary artery disease with or without stable angina, patients awaiting orthopedic surgery could join classes of aerobic exercise training as well as resistance training to increase their CRF prior to surgery and thus improve their prognosis. In addition, it has previously been shown that continuous and interval training were equally effective in patients with coronary artery disease.…”

“…15,16 Enhancing physical function through perioperative exercise programs has been demonstrated to improve outcomes among patients undergoing both cardiac and noncardiac surgery, including hepatic transplantation, lung cancer resection, abdominal aortic aneurysm (AAA) repair, upper gastrointestinal surgery, intra-abdominal surgery, bariatric surgery, and coronary artery bypass grafting (CABG). [8][9][10][11][12][13][14][17][18][19][20][21][22][23][24][25][26][27][28] Some notable studies in this area along with key results are outlined in Table 1. 22,[29][30][31][32][33][34][35][36][37][38] Note that the application of prehabilitation to cardiac and pulmonary rehabilitation is relatively recent, and the benefits of prehabilitation have been shown to apply across the spectrum of chronic conditions.…”

“…This approach has been widely used in recent years outside the United States where there tends to be a much greater emphasis on prevention and rehabilitation 15,16. Enhancing physical function through perioperative exercise programs has been demonstrated to improve outcomes among patients undergoing both cardiac and noncardiac surgery, including hepatic transplantation, lung cancer resection, abdominal aortic aneurysm (AAA) repair, upper gastrointestinal surgery, intra-abdominal surgery, bariatric surgery, and coronary artery bypass grafting (CABG) 8–14,17–28. Some notable studies in this area along with key results are outlined in Table 1 22,29–38.…”