Should patients reach certain knee function benchmarks before anterior cruciate ligament reconstruction? Does intense ‘prehabilitation’ before anterior cruciate ligament reconstruction influence outcome and return to sports?

Recovery after anterior cruciate ligament (ACL) reconstruction remains imperfect, as shown by mediocre return to sports results in recent systematic reviews.1 In the March 2015 issue, Grindem et al 2 asked whether intense preoperative rehabilitation could improve outcome after ACL reconstruction. They compared preoperative and 2-year postoperative patient-reported knee function in two different cohorts of patients undergoing primary unilateral ACL reconstruction. One cohort included patients who underwent rehabilitation at a sports medicine clinic, ‘rehabilitation cohort’, and the other cohort consisted of patients in the Norwegian national registry, representing ‘usual care’. Patients in both cohorts were considered similar with respect to sex, age, time to surgery, graft and prevalence of concomitant injuries. In the rehabilitation cohort, patients underwent an intense 5-week preoperative rehabilitation programme, with the aim to regain at least 90% hamstring and quadriceps strength (as measured isokinetically in a seated position) and 90% hop performance, prior to surgery. ACL reconstruction was performed at one of seven different hospitals. The postoperative rehabilitation was …