ACL Prehab (prehabilitation)

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Should I be doing anything about my knee prior to surgery?

ACL injuries are common in both contact and non-contact sports. For many, this can be a season ending injury, leaving our patients feeling helpless, especially those who may need to wait up to months for surgery and post-operative rehabilitation to commence. This is where ACL prehab comes into play.


During surgical waiting periods we often see a decline in muscle function, proprioception and balance. The longer the wait time, the worse this can become.

In addition to this, sitting around and not taking an active approach can also lead to weight gain and other potential comorbidities.

ACL prehab can help combat these concerns!

What is prehabilitation?

Prehabilitation is the period of time between the time of injury and that of the corrective surgery. This time frame is allocated to optimising physical function preoperatively with the aim to enable you to achieve a superior recovery during and after surgery.

ACL prehab may consist of aerobic, strength and functional-based exercises. These should be tailored to each individual’s needs.

How does this affect my surgery?

Studies have shown that patients who complete ACL Prehab protocols manifests in improvements for up to 6 years post operatively, compared to those that do not take action. These improvements apply across knee related strength, range of motion, function and outcome measure scores eg. Lysholm scores, Tegner activity scores, the lower extremity functional scale and the functional hop test (Amaravati & Sekaran, 2013; Alshewaier, Yeowell & Fatoye, 2016).

For individuals who may have gained weight during their Orthopaedic waiting period, it has been shown that higher BMI can be associated with worse outcomes on the IKDC following surgery, this looks at symptoms, sports activity and knee function (Kowalchuk, Harner, Fu & Irrgang, 2009). This is a concern that can also be addressed with the appropriate ACL Prehab.

 How long should I wait to have surgery?

Within the literature there is a recommended window of 3 weeks – 6 months in which you should receive an ACL reconstruction (Razi et al., 2012). Action within this period reduces your chance of further instability-related injuries (Razi et al., 2012). Where you may fall within this period is dependent upon a number of factors such as completion of an intensive rehabilitation program, psychological preparation and economical support (Razi et al., 2012).

How much prehabilitation would I need to do to see a positive effect post-surgery?

Research shows clear evidence that as little as 3 weeks of the appropriate ACL prehab exercises can improve knee function and strength for up to 12 months post-surgery (Razi et al., 2012).

Another good indicator for the length of ACL prehab is the ability to achieve 80% quadricep strength compared to the unaffected side. Patients who achieve this milestone minimise their chance of persistent strength differences for up to 2 years post-surgery (Eitzen, Holm & Risberg, 2009).

How can I get started?

ACL prehab exercises will vary, therefore a good option to getting started is to book in with your physiotherapist to get a detailed and personalised prehabilitation plan that is suited to your knee. This will ensure that you are on the right pathway to recovery!

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Alshewaier, S., Yeowell, G., & Fatoye, F. (2016). The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. Clinical Rehabilitation31(1), 34-44. doi: 10.1177/0269215516628617

Amaravati, R., & Sekaran, P. (2013). Does Preoperative Exercise Influence the Outcome of ACL Reconstruction?. Arthroscopy: The Journal Of Arthroscopic & Related Surgery29(10), e182-e183. doi: 10.1016/j.arthro.2013.07.252

Eitzen, I., Holm, I., & Risberg, M. (2009). Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. British Journal Of Sports Medicine43(5), 371-376. doi: 10.1136/bjsm.2008.057059

Kowalchuk, D., Harner, C., Fu, F., & Irrgang, J. (2009). Prediction of Patient-Reported Outcome After Single-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy: The Journal Of Arthroscopic & Related Surgery, 25(5), 457-463. doi: 10.1016/j.arthro.2009.02.014

Månsson, O., Kartus, J., & Sernert, N. (2012). Pre-operative factors predicting good outcome in terms of health-related quality of life after ACL reconstruction. Scandinavian Journal Of Medicine & Science In Sports23(1), 15-22. doi: 10.1111/j.1600-0838.2011.01426.x

Razi, M., Salehi, S., Dadgostar, H., Cherati, A. S., Moghaddam, A. B., Tabatabaiand, S. M., Dodaran, M. S. (2012). Timing of Anterior Cruciate Ligament Reconstruction and Incidence of Meniscal and Chondral Injury within the Knee. International Journal of Preventive Medicine4(1), 98-103. PMCID: PMC3665035