Prehabilitation before ACL reconstruction

A very swollen, stiff knee with an inhibited quadriceps complicates the early post-operative period. Prehabilitation aims to improve the starting condition, not to delay without reason.

The schedule also depends on associated injuries and surgical advice.

• Full extension or close to the opposite side.
• Functional flexion.
• Reduced effusion and controlled gait.
• Quadriceps activation and strength.

Work combines mobility, progressive strengthening, single-leg control, and tolerated cardiovascular activity. The knee's reaction within 24 hours guides the load.

No universal exercise replaces evaluation; an associated meniscal or ligamentous injury may require adaptations.

Prepare crutches, transport, sick leave, home environment, and follow-up appointments. Learn instructions for wound care, medication, and warning signs.

Clarify planned associated procedures, as a meniscal repair may change weight-bearing and flexion.

Before the procedure, the team can document mobility, effusion, gait, strength, and confidence. These benchmarks are not an exam to pass: they serve to individualize the starting point.

Ask what criteria are desired before surgery and which ones should not delay a procedure made necessary by an associated injury.

• Ask for the contact plan after discharge.
• Check fasting and medication instructions with the team.

Prehabilitation is not just about strengthening. Understanding expected restrictions, organizing the return home, and knowing who to call reduces the mental load around the surgery. Activity progression remains guided by the knee and instructions: trying to reach a maximum level at all costs just before surgery is not the goal.

Ask how the surgeon, anesthesia, and physical therapy will be coordinated, what documents to bring on the day of surgery, and if usual treatment needs to be adapted. Check the conditions for returning home, stairs, work, and the presence of a loved one for the first few days.

These benchmarks are used to prepare a clinical discussion and understand the possible choices. They do not allow for a remote conclusion on an injury, treatment, or schedule: the context, examination, and any associated procedures remain determining factors.

To delve deeper into "Prehabilitation before ACL reconstruction," revisit the elements of the sections "Why prepare the knee" and "An individualized program" with your own timeline. It is useful to separate what is certain—date of injury, report, triggering activity—from what remains an impression, such as the sensation of weakness or giving way. This distinction makes the information easier for the team to interpret.

The cited publications describe populations and trends; they do not replace the instructions of the team that knows your case. During the consultation, ask how general information applies to your situation, what limitations it has, and what signs would justify making contact before the planned follow-up.

After the discussion, note the next step, the person to contact, and symptoms to monitor. If an answer seems contradictory to a report or written instruction, ask for clarification rather than modifying weight-bearing, activities, or medications on your own.

• Aspetar 2023. Clinical Practice Guideline on Rehabilitation after ACL reconstruction.
• AAOS 2022. Management of Anterior Cruciate Ligament Injuries — Clinical Practice Guideline.
• BJSM 2022. OPTIKNEE consensus recommendations to optimise knee health after traumatic knee injury.
• Failla 2016. Does extended preoperative rehabilitation influence outcomes after ACL reconstruction?