Top

BMC Musculoskeletal Disorders

Published in:

01-12-2020 | Research article

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

Authors: Hayley M. Carter, Chris Littlewood, Kate E. Webster, Benjamin E. Smith

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR).

Method

A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence.

Results

The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored ‘high’ risk of bias.

PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks).

Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes.

Conclusion

Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport.

Trial registration

PROSPERO trial registration number. CRD42020162754.

Available only for authorised users

Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44:1502–7. https://doi.org/10.1177/0363546516629944.CrossRefPubMed

Shea KG, Carey JL, Richmond J, Sandmeier R, Pitts RT, Polousky JD, et al. The American Academy of Orthopaedic surgeons evidence-based guideline on management of anterior cruciate ligament injuries. J Bone Joint Surg Am. 2015;97:672–4. https://doi.org/10.2106/JBJS.N.01257.CrossRefPubMed

Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41:1549–58. https://doi.org/10.1177/0363546513489284.CrossRefPubMed

Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: a narrative review. EFORT Open Rev. 2017;2:410–20. https://doi.org/10.1302/2058-5241.2.170011.CrossRefPubMedPubMedCentral

Wilk KE, Arrigo CA. Preoperative phase in the rehabilitation of the patient undergoing anterior cruciate ligament reconstruction. Oper Tech Sports Med. 2016;24:12–20. https://doi.org/10.1053/j.otsm.2015.10.003.CrossRef

Alshewaier S, Yeowell G, Fatoye F. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. Clin Rehabil. 2017;31:34–44. https://doi.org/10.1177/0269215516628617.CrossRefPubMed

Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 consensus statement on return to sport from the first world congress in sports physical therapy, Bern. Br J Sports Med. 2016;50:853–64. https://doi.org/10.1136/bjsports-2016-096278.CrossRefPubMed

Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606. https://doi.org/10.1136/bjsm.2010.076364.CrossRefPubMed

Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step Back to move forward. Sport Med. 2017;47:1487–500. https://doi.org/10.1007/s40279-017-0674-6.CrossRef

10.

Webster KE, Feller JA. Expectations for return to Preinjury sport before and after anterior cruciate ligament reconstruction. Am J Sports Med. 2019;47:578–83. https://doi.org/10.1177/0363546518819454.CrossRefPubMed

11.

Christino MA, Fleming BC, Machan JT, Shalvoy RM. Psychological factors associated with anterior cruciate ligament reconstruction recovery. Orthop J Sport Med. 2016;4:2325967116638341. https://doi.org/10.1177/2325967116638341.CrossRef

12.

Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48:1613–9. https://doi.org/10.1136/bjsports-2014-093842.CrossRefPubMed

13.

Müller U, Krüger-Franke M, Schmidt M, Rosemeyer B. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surgery, Sport Traumatol Arthrosc. 2015;23:3623–31. https://doi.org/10.1007/s00167-014-3261-5.CrossRef

14.

Brand E, Nyland J. Patient outcomes following anterior cruciate ligament reconstruction: the influence of psychological factors. Orthopedics. 2009;32:335. https://doi.org/10.3928/01477447-20090502-01.CrossRefPubMed

15.

Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47:1120–6. https://doi.org/10.1136/bjsports-2012-091203.CrossRefPubMed

16.

Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surgery, Sport Traumatol Arthrosc. 2015;23:752–62. https://doi.org/10.1007/s00167-013-2699-1.CrossRef

17.

Te Wierike SCM, Van Der Sluis A, Van Den Akker-Scheek I, Elferink-Gemser MT, Visscher C. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand J Med Sci Sport. 2013;23:527–40. https://doi.org/10.1111/sms.12010.CrossRef

18.

Webster KE, McPherson AL, Hewett TE, Feller JA. Factors associated with a return to Preinjury level of sport performance after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2019;47:2557–62. https://doi.org/10.1177/0363546519865537.CrossRefPubMed

19.

Coronado RA, Bird ML, Van Hoy EE, Huston LJ, Spindler KP, Archer KR. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review. Clin Rehabil. 2018;32:287–98. https://doi.org/10.1177/0269215517728562.CrossRefPubMed

20.

Webster KE, Feller JA. A research update on the state of play for return to sport after anterior cruciate ligament reconstruction. J Orthop Traumatol. 2019;20. https://doi.org/10.1186/s10195-018-0516-9.

21.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

22.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366. https://doi.org/10.1136/bmj.l4898.

23.

McHugh ML. Interrater reliability: the kappa statistic. Biochem Medica. 2012;22:276–82. https://doi.org/10.11613/bm.2012.031.CrossRef

24.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Chinese J Evidence-Based Med. 2009;9:8–11. https://doi.org/10.1136/bmj.39489.470347.CrossRef

25.

Schünemann H, Brożek J, Guyatt G, Oxman A. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. BMJ. 2013;332:1089–92. https://doi.org/10.1136/bmj.332.7549.1089.CrossRef

26.

Page, MJ, Higgins JPT SJ. Chapter 13: Assessing risk of bias due to missing results in a synthesis. I n Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). In: Cochrane Handbook for Systematic Reviews of Interventions Versio 6.0. Available from www.training.cochrane.org/handbook (Updated July 2019).

27.

Shaarani SR, O’Hare C, Quinn A, Moyna N, Moran R, O’Byrne JM. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:2117–27. https://doi.org/10.1177/0363546513493594.CrossRefPubMed

28.

Kim DK, Hwang JH, Park WH. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction. J Phys Ther Sci. 2015;27:2693–6. https://doi.org/10.1589/jpts.27.2693.CrossRefPubMedPubMedCentral

29.

Wallace BC, Dahabreh IJ, Trikalinos TA, Lau J, Trow P, Schmid CH. Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw. 2012;49:1–15. https://doi.org/10.18637/jss.v049.i05.CrossRef

30.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Editio. Routledge; 1988. https://doi.org/10.4324/9780203771587.CrossRef

31.

Hartigan E, Axe MJ, Snyder-Mackler L. Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers. J Orthop Res. 2009;27:724–9. https://doi.org/10.1002/jor.20754.CrossRefPubMedPubMedCentral

32.

Moseley AM, Rahman P, Wells GA, Zadro JR, Sherrington C, Toupin-April K, et al. Agreement between the Cochrane risk of bias tool and physiotherapy evidence database (PEDro) scale: a meta-epidemiological study of randomized controlled trials of physical therapy interventions. PLoS One. 2019;14:e0222770. https://doi.org/10.1371/journal.pone.0222770.CrossRefPubMedPubMedCentral

33.

Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L, et al. Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? A Comparative Effectiveness Study between the MOON and Delaware-Oslo ACL Cohorts. Am J Sports Med. 2016;44:2608–14. https://doi.org/10.1177/0363546516652594.CrossRefPubMedPubMedCentral

34.

Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2015;49:385–9. https://doi.org/10.1136/bjsports-2014-093891.CrossRefPubMed

35.

Logerstedt D, Lynch A, Axe MJ, Snyder-Mackler L. Symmetry restoration and functional recovery before and after anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc. 2013;21:859–68. https://doi.org/10.1007/s00167-012-1929-2.CrossRef

36.

Sterne JAC, Hernán MA, McAleenan A, Reeves BC HJ. Chapter 25: Assessing risk of bias in a non-randomized study | Cochrane Training. Higgins JPT, Thomas J, Chandl J, Cumpst M, Li T, Page MJ, Welch VA (editors). In: Cochrane Handbook for Systeamtic Reviews of Interventions Version 6.0. Available from www.training.cochrane.org/handbook. (Updated July 2019).

37.

Flanigan DC, Everhart JS, Pedroza A, Smith T, Kaeding CC. Fear of reinjury (Kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthrosc - J Arthrosc Relat Surg. 2013;29:1322–9. https://doi.org/10.1016/j.arthro.2013.05.015.CrossRef

38.

Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc. 2005;13:393–7. https://doi.org/10.1007/s00167-004-0591-8.CrossRef

39.

Edwards PK, Ebert JR, Joss B, Ackland T, Annear P, Buelow JU, et al. Patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction: the importance of patient age and postoperative rehabilitation. Orthop J Sport Med. 2018;6. https://doi.org/10.1177/2325967118797575.

40.

Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9:9–15. https://doi.org/10.1016/j.ptsp.2007.09.003.CrossRefPubMed

41.

Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med. 2009;43:377–81. https://doi.org/10.1136/bjsm.2007.044818.CrossRefPubMed

42.

Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48:1543–52. https://doi.org/10.1136/bjsports-2013-093398.CrossRefPubMed

43.

Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surgery, Sport Traumatol Arthrosc. 2006;14:1021–8. https://doi.org/10.1007/s00167-006-0050-9.CrossRef

44.

Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J. Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surgery, Sport Traumatol Arthrosc. 2008;16:118–27. https://doi.org/10.1007/s00167-007-0433-6.CrossRef

45.

Culvenor A, Crossley K, Kvist J, McPhail S. Functional recovery 1-year post-ACL reconstruction predicts future quality adjusted life years (QALY) in 3,187 patients. J Sci Med Sport. 2019;22:S57. https://doi.org/10.1016/j.jsams.2019.08.252.CrossRef

46.

Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, et al. Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med. 2015;49:335–42. https://doi.org/10.1136/bjsports-2013-092299.CrossRefPubMed

47.

Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–8. https://doi.org/10.1136/bjsports-2016-096031.CrossRefPubMed

48.

Ebert JR, Webster KE, Edwards PK, Joss BK, D’alessandro P, Janes G, et al. Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey; 2019. https://doi.org/10.1016/j.ptsp.2018.12.004.CrossRef

49.

Ebert JR, Webster KE, Edwards PK, Joss BK, D’Alessandro P, Janes G, et al. Current perspectives of the Australian knee society on rehabilitation and return to sport after anterior cruciate ligament reconstruction. J Sport Rehabil. 2019;1:1–6. https://doi.org/10.1123/jsr.2019-0291.CrossRef

50.

Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sport Med. 2017;47:221–32. https://doi.org/10.1007/s40279-016-0584-z.CrossRef

Title: The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review
Authors: Hayley M. Carter
Chris Littlewood
Kate E. Webster
Benjamin E. Smith
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03676-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

Abstract

Background

Method

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2020

Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: a Bayesian meta-analysis

The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture

Cross-cultural adaptation and validation of the Romanian knee disability and osteoarthritis outcome score for joint replacement (KOOSJR)

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) – protocol for a multicenter randomized clinical trial