PREOPERATIVE PREHABILITATION AS A PREDICTOR OF IMPROVED FUNCTIONAL OUTCOMES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A RANDOMIZED CONTROLLED TRIAL

Background: Anterior cruciate ligament (ACL) injuries are one of the most common injuries in physically active people and athletes, often resulting in ACL reconstruction surgery and a length of rehabilitation. Despite the improvements in the surgical procedures and postoperative rehabilitation, many patients do not return to the same functional level as before the injury or even return to sport. Prehabilitation (strengthening exercises before surgery) has recently been recommended as a method to enhance postoperative results after reconstruction by enhancing neuromuscular preparation and physical fitness. But data on its effectiveness with regard to functional recovery after surgery is still scarce. Thus, in the present study, the efficacy of a structured prehabilitation intervention on functional outcomes after anterior cruciate ligament reconstruction (ACLR) was assessed.Methods: A prospective randomized controlled trial was performed with 76 patients that were diagnosed with a complete anterior cruciate ligament rupture (ACL) and were scheduled for primary anterior cruciate ligament reconstruction (ACL-R). The participants were randomly allocated to a prehabilitation group (n = 38) where they underwent a structured six-week prehabilitation program or a control group (n = 38) and were treated in a usual care pre-surgical manner. Progressive strengthening exercises, neuromuscular training, balance training and functional movement training made up the prehabilitation protocol, which was carried out three times a week. Outcome measures were evaluated at baseline, pre-op and 3 and 6 months post-op. Functional outcomes were assessed by international knee documentation committee score, knee injury and osteoarthritis outcome score, tegner activity scale and functional performance tests (Single-Leg Hop Test). Repeated measures ANOVA and independent t-tests were used in the statistical analysis with a p value of < 0.05 considered significant.Results: The prehabilitation group had significantly more improvement in functional outcomes than the control group. At six months postoperatively, the prehabilitation group achieved higher IKDC scores (86.1 ± 6.9 vs. 78.4 ± 7.5, p<0.001) and higher KOOS scores (88.7 ± 6.3 vs. 82.1 ± 7.0, p<0.001). The intervention group had also significantly more activity levels (6.1 ± 1.0 vs. 5.3 ± 1.1, p = 0.001) as measured by the Tegner Activity Scale. Limb symmetry in functional performance using single leg hop test showed that prehabilitation group had more symmetrical function (94.5 ± 5.2 %) than control group (88.1 ± 6.4 %), p<0.001). There was a significant time by intervention interaction for all outcome measures with repeated measures analysis.Conclusion: Prehabilitation prior to anterior cruciate ligament reconstruction in a structured program leads to a great improvement of functional outcomes, activity levels, and neuromuscular performance postoperatively. Prehabilitation could be a part of the usual ACL rehabilitation pathway to improve recovery and return to physical activity. These results argue for the use of prehabilitation as a key part of an integrated approach to the care of the ACL injury.Trial registration : registered at clinicaltrails.gov(NCT07627724) at 31 may 2026 “Retrospectively registered” This study was reported in accordance with the CONSORT guidelines for randomized clinical trials