Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 3;21(1):647.
doi: 10.1186/s12891-020-03676-6.

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

Hayley M Carter  1 , Chris Littlewood  2 , Kate E Webster  3 , Benjamin E Smith  4   5
Affiliations

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

Hayley M Carter et al. BMC Musculoskelet Disord. .

Abstract

Background: To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR).

Method: A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence.

Results: The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes.

Conclusion: Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport.

Trial registration: PROSPERO trial registration number. CRD42020162754 .

Keywords: Anterior cruciate ligament (ACL); Postoperative outcomes; Rehabilitation; Systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2009 Flow Diagram
Fig. 2
Fig. 2
Risk of Bias Summary
Fig. 3
Fig. 3
Risk of Bias Graph
See this image and copyright information in PMC

References

    1. Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44:1502–1507. doi: 10.1177/0363546516629944. - DOI - PubMed
    1. Shea KG, Carey JL, Richmond J, Sandmeier R, Pitts RT, Polousky JD, et al. The American Academy of Orthopaedic surgeons evidence-based guideline on management of anterior cruciate ligament injuries. J Bone Joint Surg Am. 2015;97:672–674. doi: 10.2106/JBJS.N.01257. - DOI - PubMed
    1. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41:1549–1558. doi: 10.1177/0363546513489284. - DOI - PubMed
    1. Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: a narrative review. EFORT Open Rev. 2017;2:410–420. doi: 10.1302/2058-5241.2.170011. - DOI - PMC - PubMed
    1. Wilk KE, Arrigo CA. Preoperative phase in the rehabilitation of the patient undergoing anterior cruciate ligament reconstruction. Oper Tech Sports Med. 2016;24:12–20. doi: 10.1053/j.otsm.2015.10.003. - DOI

Publication types

MeSH terms