Background: Preoperative therapy has been increasingly proposed as a strategy to optimize recovery outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction. This meta-analysis aimed to evaluate the effectiveness of preoperative therapeutic interventions compared to non-therapeutic approaches in enhancing post-surgical recovery. Methods: A systematic review of the literature was conducted, and eligible studies that compared preoperative therapy with non-therapeutic approaches in ACL repair were identified. Data were extracted on various clinical outcomes, including knee mobility, overall knee function, and patient-reported quality of life. The methodological quality of the studies was rigorously assessed and a meta-analytical synthesis was performed. Findings: The results revealed that patients receiving preoperative therapy exhibited superior knee mobility and overall knee health post-surgery. However, improvements in overall knee function were similar between the two groups, suggesting that preoperative therapy may have a targeted benefit on specific functional parameters rather than a global impact. Conclusion: Preoperative therapeutic interventions appear to offer significant advantages in terms of knee mobility and overall knee health in the context of ACL reconstruction, although both preoperative and non-therapeutic approaches yield comparable results in overall knee function. These findings underscore the potential of tailored preoperative strategies to enhance targeted aspects of post-surgical recovery. Further research is warranted to identify the most effective components of preoperative therapy and their long-term impacts on patient outcomes. Additionally, integrating patient-specific factors into the design of preoperative protocols could optimize recovery trajectories and improve personalized care in ACL reconstruction.
| Published in | American Journal of Sports Science (Volume 13, Issue 2) |
| DOI | 10.11648/j.ajss.20251302.13 |
| Page(s) | 39-49 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2025. Published by Science Publishing Group |
Anterior Cruciate Ligament Reconstruction, Preoperative Therapy, Knee Mobility, Post-surgical Recovery
PICOS | Inclusion Criteria | Exclusion Criteria |
|---|---|---|
1. Population | Age: 20–30 years, scheduled for ACL reconstructive surgery, Participating in preoperative rehabilitation. | Age <20 or >30 years, Acute ACL rupture, Complex knee injury (e.g., multi-ligament tears). |
2. Intervention | Pre-reconstruction physiotherapy program. | Patients undergoing conservative treatment. |
3. Comparison | Postoperative rehabilitation only | No rehabilitation program |
4. Outcomes | KOOS (Knee Injury and Osteoarthritis Outcome Score), Lysholm Score. | Outcomes collected at inconsistent time points, Non-comparable outcome measures. |
5. Study Design | Randomized controlled trial (RCT), Cohort studies, Case series. | Meta-analyses, Systematic reviews, Case reports. |
Search terms with Boolean operators AND, OR | |
|---|---|
Pub Med | ("Anterior Cruciate Ligament"[Mesh] OR "ACL Rupture" OR "ACL Tear" OR "ACL Reconstruction") AND ("Preoperative Rehabilitation" OR "Pre-reconstruction Rehabilitation" OR "Pre-operative Exercise" OR "Pre-rehabilitation") AND ("None Rehabilitation" OR "No Rehabilitation") AND ("Functional Score" OR "KOOS" OR "Quality of Life" OR "Postoperative Function") |
EMBASE | ('Anterior Cruciate Ligament Reconstruction'/exp OR 'ACL Rupture' OR 'ACL Tear') AND ('Preoperative Rehabilitation' OR 'Pre-reconstruction Rehabilitation' OR 'Preoperative Exercise' OR 'Pre-habilitation') AND ('No Rehabilitation' OR 'None Rehabilitation') AND ('Functional Score' OR 'KOOS' OR 'Quality of Life' OR 'Postoperative Function') |
Scopus | Title-Abs-Key ("Anterior Cruciate Ligament" OR "ACL Rupture" OR "ACL Tear" OR "ACL Reconstruction") AND Title-Abs-Key ("Preoperative Rehabilitation" OR "Pre-reconstruction Rehabilitation" OR "Pre-operative Exercise" OR "Pre-rehabilitation") AND Title-Abs-Key ("No Rehabilitation" OR "None Rehabilitation") AND Title-Abs-Key ("Functional Score" OR "KOOS" OR "Quality of Life" OR "Postoperative Function") |
Cochrane | [Title-Abs-Key] ("Anterior Cruciate Ligament" OR "ACL Rupture" OR "ACL Tear" OR "ACL Reconstruction") AND [Title-Abs-Key] ("Preoperative Rehabilitation" OR "Pre-reconstruction Rehabilitation" OR "Pre-operative Exercise" OR "Pre-rehabilitation") AND [Title-Abs-Key] ("No Rehabilitation" OR "None Rehabilitation") AND [Title-Abs-Key] ("Functional Score" OR "KOOS" OR "Quality of Life" OR "Postoperative Function") |
Google Scholar | ("Anterior Cruciate Ligament" OR "ACL Rupture" OR "ACL Tear" OR "ACL Reconstruction") AND ("Preoperative Rehabilitation" OR "Pre-reconstruction Rehabilitation" OR "Pre-operative Exercise" OR "Pre-rehabilitation") AND ("No Rehabilitation" OR "None Rehabilitation") AND ("Functional Score" OR "KOOS" OR "Quality of Life" OR "Postoperative Function") |
Medline | ("Anterior Cruciate Ligament"[Mesh] OR "ACL Rupture" OR "ACL Tear" OR "ACL Reconstruction") AND ("Preoperative Rehabilitation" OR "Pre-reconstruction Rehabilitation" OR "Pre-operative Exercise" OR "Pre-rehabilitation") AND ("No Rehabilitation" OR "None Rehabilitation") AND ("Functional Score" OR "KOOS" OR "Quality of Life" OR "Postoperative Function") AND ("Randomized Controlled Trial"[pt] OR "Clinical Trial"[pt]) And ("2010"[Date - Publication]: "2025"[Date - Publication]) And (English [Lang]) |
Reporting | External validity | Internal validity (bias) | Internal validity (confounding) | Power | Score (%) | Quality | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 10 | 11 | 12 | 15 | 16 | 18 | 20 | 21 | 22 | 25 | 27 | |||
Amaravati, & Sekaran [ 16] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 79 | HQ |
Failla et al. [ 17] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 68 | MQ |
Grindem et al. [ 18] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 79 | HQ |
Reddy et al. [ 19] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 68 | MQ |
Dai et al. [ 20] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 68 | MQ |
Alit Pawana [ 21] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 68 | MQ |
Simonsson et al, [ 22] | 1 | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 68 | MQ |
71 | MQ | |||||||||||||||||||
Authors | Intervention Group (Preoperative Therapy) | Control Group (Non-Therapeutic) | Graft type | Time since surgery | Rehabilitation Protocol | Functional Outcomes | Biomechanical Assessments | Adherence to Therapy | Notes/Comments |
|---|---|---|---|---|---|---|---|---|---|
Amaravati, & Sekaran [ 16] | 15 M and 18 F | 15 M and 18 F | Hamstring | 6-12 Month | Structured preoperative exercise program | Improved ROM (extension/flexion), Lysholm scores (95.5 vs. 89.32), Tegner activity scores (5.06 vs. 4.2), LEFS (76.2 vs. 72.1), IROC scores (85.9 vs. 80.9), and hop test limb symmetry (85% vs. 80.9%) Improved dynamic postural stability (DMA scores: 611 pre-op vs. 403 at 9 months; time on platform increased from 87.7 s to 106.7 s) | KT-1000 for graft integrity (side-to-side difference improved from 3.3 mm to 1.6 mm); multidirectional platform for postural stability | NR | Postural stability improved progressively up to 9 months post-op, suggesting delayed return to sport (>6 months) may optimize recovery |
Failla et al. [ 17] | DOC: 92, MOON: 95, Age: NR, Sex: NR | DOC: 92, MOON: 95, Age: NR, Sex: NR | Hamstring autografts (51%). Patellar tendon autografts (48%). Other graft types | 2 years postoperatively | Preoperative: Progressive strengthening and neuromuscular training. Postoperative: Criterion-based protocol with objective measures (strength, ROM, functional testing) and structured follow-up at 6, 12, and 24 months. | IKDC scores: 84 ± 25 vs. 71 ± 32 (p < 0.001). KOOS subscales (pain, symptoms, ADL, sports/recreation): Significantly higher in DOC (p ≤ 0.006). Return-to-sport (RTS) rates: 72% (DOC) vs. 63% (MOON) (p < 0.001) | KT-1000: Improved side-to-side difference in MOON cohort (pre-op: 3.3 mm → post-op: 1.6 mm). Multidirectional platform: Used for dynamic postural stability testing in DOC. | NR | Extended preoperative rehabilitation (DOC) led to superior functional outcomes and higher RTS rates compared to standard care (MOON). |
Grindem et al. [ 18] | NAR: 84 (39 M, 45 F), NKLR: 2690 (1367 M, 1328 F) | NAR: 84 (39 M, 45 F), NKLR: 2690 (1367 M, 1328 F) | Hamstring autograft: 63.1% Bone-patellar tendon-bone (BPTB): 36.9% | 2 years postoperatively. | Progressive strength/neuromuscular training | KOOS Scores, Return to Sport | Hop tests (single-legged hop symmetry ≥90%) and strength criteria | NAR: 89.4% follow-up rate at 2 years. NKLR: 46.6% included due to missing data; adherence not explicitly reported | NAR cohort had superior 2-year KOOS scores and higher RTS rates |
Reddy et al. [ 19] | 19 M, 1 F | 19 M, 2 F | Hamstring Graft | 3 weeks, 6 weeks, 3 months, and 6 months | Pre-surgery: Focused on reducing pain/swelling, restoring ROM, and muscle strength. Post-surgery: Continuation of exercises with gradual progression (e.g., weight-bearing, brace-free mobilization, sport-specific drills). | Lysholm Scores, IKDC Scores | Range of Motion (ROM), Lachman Test | Group P demonstrated better compliance with exercises during early rehabilitation (3 weeks). | Preoperative rehabilitation improved early functional outcomes (3–6 weeks post-op). |
Dai et al. [ 20] | 104 patients. | 104 patients. | Autograft | 2 days, 6 weeks, 12 weeks, and 24 weeks | CTG: Manual Therapy: Sports injury massage. Electrotherapy: Muscle activation and pain management. Exercise Therapy: ROM exercises (3 sessions/week for 4 weeks). Cryotherapy: Ice application post-exercise. ERG: Exercise Therapy: ROM exercises only (same frequency and duration as CTG). | Lysholm Scores, IKDC Scores, Isometric Strength, Limb Swelling Index | Joint Angle (ROM), | 60°/s Isokinetic Strength | All sessions were therapist-supervised to ensure protocol adherence |
Alit Pawana [ 21] | 32 M | 32 M | NR | 12 weeks post-operation | Preoperative Protocol: Restore knee range of motion (ROM). Strengthen lower extremity muscles (emphasis on quadriceps). Improve balance and proprioception Enhance psychological readiness for return to activity | Improved Modified Cincinnati Knee Rating System scores. Higher single-leg hop distance and Limb Symmetry Index (LSI) in the preoperative group. Increased psychological readiness for return to sports | Surface EMG | NR | Preoperative rehabilitation enhances neuromuscular control and reduces the risk of re-injury or contralateral injury |
Simonsson et al, [ 22] | High-Volume Clinics (HV): >100 patient registrations (n=1221). | Low-Volume Clinics (LV): ≤100 registrations (n=733). | Hamstring Graft | Follow-ups at 2-, 4-, 8-, 12-, 18-, and 24 months post-op | Individualized programs with muscle function tests and PROs. | Tegner Scores, KOOS Scores | Muscle Strength: HV had higher hamstring symmetry at 2 months (83.3% vs. 78.4%). | Registry-based follow-ups (Project ACL). | No clinically relevant differences in second ACL injury rates or long-term outcomes. |
ACL | Anterior Cruciate Ligament |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
CENTRAL | Cochrane Central Register of Controlled Trials |
PICOS | Population, Intervention, Comparison, Outcome, Study Design |
Mesh | Medical Subject Headings |
BMI | Body Mass Index |
RCT | Randomized Controlled Trial |
SMD | Standardized Mean Difference |
CI | Confidence Intervals |
KOOS | Knee Injury and Osteoarthritis Outcome Score |
ROM | Range of Motion |
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APA Style
Piri, E. (2025). Evaluating Post-Surgical Recovery in ACL Repair: A Meta-Analytical Review of Preoperative Therapy Versus Non-Therapeutic Approaches. American Journal of Sports Science, 13(2), 39-49. https://doi.org/10.11648/j.ajss.20251302.13
ACS Style
Piri, E. Evaluating Post-Surgical Recovery in ACL Repair: A Meta-Analytical Review of Preoperative Therapy Versus Non-Therapeutic Approaches. Am. J. Sports Sci. 2025, 13(2), 39-49. doi: 10.11648/j.ajss.20251302.13
AMA Style
Piri E. Evaluating Post-Surgical Recovery in ACL Repair: A Meta-Analytical Review of Preoperative Therapy Versus Non-Therapeutic Approaches. Am J Sports Sci. 2025;13(2):39-49. doi: 10.11648/j.ajss.20251302.13
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Download@article{10.11648/j.ajss.20251302.13,
author = {Ebrahim Piri},
title = {Evaluating Post-Surgical Recovery in ACL Repair: A Meta-Analytical Review of Preoperative Therapy Versus Non-Therapeutic Approaches
},
journal = {American Journal of Sports Science},
volume = {13},
number = {2},
pages = {39-49},
doi = {10.11648/j.ajss.20251302.13},
url = {https://doi.org/10.11648/j.ajss.20251302.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajss.20251302.13},
abstract = {Background: Preoperative therapy has been increasingly proposed as a strategy to optimize recovery outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction. This meta-analysis aimed to evaluate the effectiveness of preoperative therapeutic interventions compared to non-therapeutic approaches in enhancing post-surgical recovery. Methods: A systematic review of the literature was conducted, and eligible studies that compared preoperative therapy with non-therapeutic approaches in ACL repair were identified. Data were extracted on various clinical outcomes, including knee mobility, overall knee function, and patient-reported quality of life. The methodological quality of the studies was rigorously assessed and a meta-analytical synthesis was performed. Findings: The results revealed that patients receiving preoperative therapy exhibited superior knee mobility and overall knee health post-surgery. However, improvements in overall knee function were similar between the two groups, suggesting that preoperative therapy may have a targeted benefit on specific functional parameters rather than a global impact. Conclusion: Preoperative therapeutic interventions appear to offer significant advantages in terms of knee mobility and overall knee health in the context of ACL reconstruction, although both preoperative and non-therapeutic approaches yield comparable results in overall knee function. These findings underscore the potential of tailored preoperative strategies to enhance targeted aspects of post-surgical recovery. Further research is warranted to identify the most effective components of preoperative therapy and their long-term impacts on patient outcomes. Additionally, integrating patient-specific factors into the design of preoperative protocols could optimize recovery trajectories and improve personalized care in ACL reconstruction.
},
year = {2025}
}
TY - JOUR T1 - Evaluating Post-Surgical Recovery in ACL Repair: A Meta-Analytical Review of Preoperative Therapy Versus Non-Therapeutic Approaches AU - Ebrahim Piri Y1 - 2025/05/24 PY - 2025 N1 - https://doi.org/10.11648/j.ajss.20251302.13 DO - 10.11648/j.ajss.20251302.13 T2 - American Journal of Sports Science JF - American Journal of Sports Science JO - American Journal of Sports Science SP - 39 EP - 49 PB - Science Publishing Group SN - 2330-8540 UR - https://doi.org/10.11648/j.ajss.20251302.13 AB - Background: Preoperative therapy has been increasingly proposed as a strategy to optimize recovery outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction. This meta-analysis aimed to evaluate the effectiveness of preoperative therapeutic interventions compared to non-therapeutic approaches in enhancing post-surgical recovery. Methods: A systematic review of the literature was conducted, and eligible studies that compared preoperative therapy with non-therapeutic approaches in ACL repair were identified. Data were extracted on various clinical outcomes, including knee mobility, overall knee function, and patient-reported quality of life. The methodological quality of the studies was rigorously assessed and a meta-analytical synthesis was performed. Findings: The results revealed that patients receiving preoperative therapy exhibited superior knee mobility and overall knee health post-surgery. However, improvements in overall knee function were similar between the two groups, suggesting that preoperative therapy may have a targeted benefit on specific functional parameters rather than a global impact. Conclusion: Preoperative therapeutic interventions appear to offer significant advantages in terms of knee mobility and overall knee health in the context of ACL reconstruction, although both preoperative and non-therapeutic approaches yield comparable results in overall knee function. These findings underscore the potential of tailored preoperative strategies to enhance targeted aspects of post-surgical recovery. Further research is warranted to identify the most effective components of preoperative therapy and their long-term impacts on patient outcomes. Additionally, integrating patient-specific factors into the design of preoperative protocols could optimize recovery trajectories and improve personalized care in ACL reconstruction. VL - 13 IS - 2 ER -
Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
Research Fields: Sport, Rehabilitation, Pronated foot, Anterior cruciate ligament reconstruction, Exercise science, Anterior cruciate ligament surgery and swimming
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