Abstract
Study designSystematic review.Background and objectivesPreoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes.MethodsA systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS).Results and conclusionsMethodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted.Registration numberPROSPERO 2017: CRD42017065491.
Highlights
Anterior cruciate ligament (ACL) reconstruction is the usual treatment for athletes after ACL tears, followed by evidence-based physical rehabilitation therapy to restore function [1, 2]
Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls
Seven studies were excluded because they were 1) no controlled trials as both groups participated in a prehabilitation programme, or 2) used a non-operative rehabilitation approach [16, 26,27,28,29,30,31]
Summary
Anterior cruciate ligament (ACL) reconstruction is the usual treatment for athletes after ACL tears, followed by evidence-based physical rehabilitation therapy to restore function [1, 2]. The RTS-decision should be based on the systematic and stepwise assessment of potential risk factors [5, 6]. The use of clinical tests to assess an athlete’s neuromuscular function of the affected limb compared to the non-affected limb expressed by limb symmetry indices (LSI) appear to be a crucial criterion for RTS decision [7,8,9]. Athletes who successfully returned to sports often display a shorter career duration and an impaired game performance compared to controls after ACL reconstruction and RTS [13]. These issues highlight the importance of strategies for the improvement of the RTS-process. The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, selfreported and RTS-specific outcomes
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