Abstract
Objectives:
Although the effectiveness of preoperative trainings prior to an ACL reconstruction is well established, no clear consensus regarding the specific content, optimal supervision (one-on-one guidance or self-administered training) and the overall framework remains. This study aimed to compare the effectiveness of an individually tailored, guided, structured, and criteria-based preoperative rehabilitation program (IG) with a non-guided, structured, self-administered home training program (CG) in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Methods:
In this assessor-blinded RCT, individuals aged 16–60 years with a unilateral ACL rupture and scheduled for ACL reconstruction using hamstring or quadriceps tendon autografts were 1:1 block-randomized into IG or CG. The primary outcome was self-reported knee function (KOOS sum score), assessed alongside functional and subjective outcomes at seven time points from anamnesis to 180 days post-surgery.
Linear mixed models were used to analyze change scores (intention-to-treat).
Results:
Among 114 participants (mean age 31.0 ± 10.3 years; 53% female), 58 dropped out or discontinued the intervention. Both groups improved preoperatively, but the IG showed a significantly greater KOOS improvement from anamnesis to the day of surgery (IG: 46.04 → 58.52; CG: 51.01 → 59.18), with a significant group*time interaction (p = 0.039). This difference persisted up to 60 days postoperative (p = 0.039), though overall effect sizes were small.
Conclusion:
An individually tailored, supervised prehabilitation program resulted in superior improvements in perceived knee function compared to a self-administered program. These findings highlight the importance of guidance and adaptive progression in prehabilitation, offering valuable insights for optimizing rehabilitation strategies before ACL reconstruction.