Friday, October 31, 2014 Pre and Post-ACLR Rehabilitation Shows Benefits 2 Years After Surgery A new study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the October 28 British Journal of Sports Medicine (abstract only available for free). Researchers compared Knee Injury and Osteoarthritis Outcome Scores (KOOS) of 84 patients who participated in progressive pre- and postoperative rehabilitation between 2007 and 2011 with 2,690 patients who received usual care between 2006 and 2010. The usual-care patient data were taken from the Norwegian National Knee Ligament Registry (NKLR); patients receiving the progressive pre- and postoperative care were from the US and Norway. Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points. Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills. Authors did not include a description of usual-care. Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write. Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.