ACL REHABILITATION: Pre- and Post-Op shows promising results even 2 YEARS after.

Pre- and Post-ACLR Rehabilitation Shows Benefits 2 Years After Surgery

This is a really good article I read online regarding a two year follow up with individuals who underwent ACL reconstruction.  Many of my athletes have expressed some form of concern as well as some mild paranoia of whether they will be able to participate in the future as competitively as they have prior to being injured.

A study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but also experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the British Journal of Sports Medicine.

Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.

Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. This is HUGE! The fact that they have recovered the quads strength means the stability will be there long term. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills.

Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but also showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.

Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.