Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction?

Abstract

Background Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. Purpose/Hypothesis The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Study Design Cohort study; Level of evidence, 3. Methods This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. Results After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). Conclusion The cohort treated with additional preoperative rehabilitation consisting of progressive strengthening and neuromuscular training, followed by a criterion-based postoperative rehabilitation program, had greater functional outcomes and RTS rates 2 years after ACLR. Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR.

On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction

“…While the case study athlete had co-morbidities and other factors that complicated her rehabilitation process, her 22-month outcomes compared favorably to recently published data from large cohorts. 14 It is likely that athletes with isolated ACL injuries could initiate the early on-ice phase sooner (i.e., ≥16 weeks versus 7 months post-operatively) and complete the entire program earlier. Nevertheless, even for the uncomplicated athlete, we recommend not initiating the return-to-sport phase until at least 9 months post-operatively due to increased risk of re-injury for returning to sport before this time-frame, even in the absence of impairments.…”

“…Her Knee Injury and Osteoarthritis Outcome Score 45 subscale scores are similar to or higher than Delaware-Oslo ACL Cohort and Multicenter Orthopaedic Outcomes Network (MOON) scores among subjects two years after ACLR. 14 …”

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“…Physiotherapists consider pre-operative rehabilitation to have an important influence on post-operative outcomes (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018). A structured physiotherapy-led pre-ACLR rehabilitation programme of up to 27 sessions has been shown to be effective and safe, and to improve outcomes two years after ACLR (Alshewaier, Yeowell, & Fatoye, 2017;Eitzen et al, 2010;Eitzen et al, 2009;Failla et al, 2016;Logerstedt et al, 2013). Our research found that 24% of people did not receive physiotherapy treatment prior to ACLR, which suggests the post-operative outcomes for almost a quarter of people in our sample may have been sub-optimal.…”

“…A structured pre-operative physical rehabilitation programme produces better post-operative functional outcomes (Eitzen, Risberg, & Holm, 2009;Failla et al, 2016;Logerstedt, Lynch, Axe, & Snyder-Mackler, 2013). Supervised physiotherapy is routinely prescribed following ACL surgery (Han, Banerjee, Shen, & Krishna, 2015), and supervised rehabilitation can be associated with better outcomes than unsupervised (Christensen, Miller, Burns, & West, 2017).…”

Study and Comparing the Short Term Follow up Result for Soft Tissue Autograft and Allograft in ACL Reconstruction Surgery

“…Additional pre-operative rehabilitation and consequently post-operative rehabilitation significantly improves the patient's functional outcome of ACL reconstruction (12).…”