Healthy Knee Tips # 32.

Can “Prehab” improve the results of ACL surgery?

What is Prehabilitation (Pre-surgery rehabilitation)?

Prehabilitation is the process of “preparing an individual to withstand a stressful event through enhancement of functional capacity.” When talking about ACL reconstruction prehab means exercising before surgery to improve quadriceps strength and lower extremity function. Players are subjected to a dedicated prehab exercise program with a trained knee joint physiotherapist. This training program mainly includes regaining range of motion, developing the lost strength and enhancement of pre-injury strength, controlled proprioceptive training and psychological build up of patient for the surgery.

International Research about importance of Prehab for ACL reconstruction

Shahril Shaarani and others published the effects of a six-week exercise program performed by patients before their ACL surgeries in the American Journal of Sports Medicine.1 They compared results of strength tests, functional performance tests, muscle biopsies, and patient outcome scores at 12 weeks after surgery between patients who completed the prehabilitation programs and those who didn’t. Only the exercise group showed significant increases on the Modified Cincinnati Knee Rating System scores compared to baseline scores at 12 weeks after surgery. The outcome scores in the exercise group were significantly higher than the group that did not undergo prehab.

The exercise group did much better on the single-leg hop test 12 weeks postoperatively than the control group did. This test is widely thought to be one of the best functional tests of lower extremity strength. Mean return to sports for the exercise group was 34.18 weeks, compared to 42.5 weeks in the control group.

Thoughts of ACL experts

Julie Eibensteiner, a physical therapist in Minneapolis, Minnesota who focuses her practice almost exclusively on athletes rehabbing from ACL injuries and surgeries; explained prehab prior to ACL reconstructive surgery as a very apparent and an important tool in the recovery process for every injured athlete. She observed that Patients who have normalized swelling, range of motion, and neuromuscular control of the quads prior to surgery tend to perform well post-operatively. Prehab also develops a positive rapport between patient and physical therapist.2

Dr. David Giere says that working with Physical Therapy program before surgery helps patients understanding the rehab protocol better and physical therapist can advise the patients about post-operative instructions and common mistakes other patients make.2

Dr Deepak Goyal, an expert Knee Sports Surgeon from India feels that Prehab not only improves the rapport between the hospital team and the player, but it also brings in the confidence about the surgery. In the department, when a player sees post-operated patients recovering well from their respective surgeries; most of his fears get eliminated. This has a big psychological support to the player. There is an additional and equally important benefit of regaining full range of motion and strength before the surgery. Post–surgery, patient already knows many physio steps and thus can follow them easily and more quickly.


Dr Shivani Patel

Masters of Physiotherapy (Musculoskeletal and Sports)

Consultant Knee Joint Physiotherapist, 

Saumya Orthocare



  1. Shaarani SR, O’Hare C, Quinn A, Moyna M, Moran R, O’Byrne JM. Effect of Prehabilitation on the Outcome of Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2013;41(9):2117-2127.
  2. http://www.drdavidgeier.com/prehab-acl-surgery/

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