Pre-operative physiotherapy rehabilitation programmes improve the outcomes of treatment following anterior cruciate ligament injury

Abstract

Background: The prevalence of anterior cruciate ligament (ACL) injury is high among athletes (Hartigan et al., 2009). Patients with ACL injury present with pain, joint instability, muscle weakness, functional limitation, reduced quality of life and increased risk of osteoarthritis of the knee (Shaarani et al., 2012). ACL reconstruction is the mainstay in the management of the injury (Kowalchuk et al., 2009) and pre-operative physiotherapy rehabilitation programmes are often used to improve the outcomes of reconstruction or as a treatment option on its own. However, the effectiveness of pre-operative physiotherapy rehabilitation programmes on the outcomes of treatment following ACL injury is not well known. Purpose: This systematic review evaluated the effectiveness of pre-operative physiotherapy rehabilitation programme on the outcomes of treatment following ACL injury. Methods: The following databases were searched for relevant literature: PubMed, Ovid (AMED, MEDLINE) and Web of Science. The keywords used were: anterior cruciate ligament injury, pre-operative rehabilitation, pre-operative exercise, pre-operative protocol, pre-operative physiotherapy, pre-operative treatment. This search was supplemented with a manual search of the references of selected studies. Methodological quality of the studies were assessed using the Physiotherapy Evidence Database (PEDro) scale. Results: In total, 108 studies were identified, out of which seven studies met the inclusion criteria and were of a moderate to high methodological quality. The average PEDro score for the studies included was 6.1, indicating that overall, the studies included were of a moderate methodological quality. The studies showed that pre-operative physiotherapy for patients with ACL injury was effective to reduce need for reconstruction, improve knee-related function and increase muscle strength. However, only one study examined quality of life, and no significant improvement was found following a pre-operative physiotherapy programme. Conclusion(s): There is evidence to suggest that preoperative physiotherapy rehabilitation is beneficial to patients with ACL injury. Further high quality studies are required to determine the effectiveness of pre-operative physiotherapy programmes on quality of life in patients with ACL injuries. Implications: Physiotherapists are to be aware of the findings of the present study as pre-operative physiotherapy may be useful to patients with this condition. Additionally, the findings provide justification for continued use of preoperative physiotherapy programme for patients with ACL injury.