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Physical therapy before ACL surgery leads to better outcomes



Surgery is the main treatment for these types of injuries


Injuries to the knee account for almost 45% of all sports-related injuries, and the anterior cruciate ligament (ACL) is the most commonly damaged structure of the knee. ACL injuries lead to pain, muscle weakness, instability of the joint and poor quality of life, and they can be a major burden on those who experience them. The main treatment for ACL injuries is a surgical procedure called ACL reconstruction, and every year over 200,000 surgeries are performed. These surgeries amount to costing more than $3 billion annually.



Physical therapy often used to increase strength and function


Prior to surgery, many patients are prescribed a course of physical therapy - pre-operative physical therapy - to prepare the knee. Pre-operative physical therapy is designed to increase muscle strength and function, and reduce further damage of the knee joint, with the overall goal of shortening the time of recovery. Although this form of physical therapy is commonly used, there is a lack of research to fully support its effectiveness for these patients. For this reason, a large-scale study called a systematic review was conducted on the topic. This systematic review compiled all the available research on pre-operative physical therapy for patients having ACL reconstruction with the aim of establishing a clear consensus on what type of effects this treatment had on patients.



Researchers only accept high-quality studies on the topic


To perform the review, researchers searched through four major medical databases for appropriate studies on the topic. They only accepted studies called randomized-controlled trials (RCTs) that included patients suffering from ACL injuries treated with pre-operative physical therapy. An RCT is a high-quality individual study - as opposed to systematic reviews, which are collections of studies - that randomly assigns patients to different groups for treatment and then evaluates which one experiences better results. This search led to 500 RCTs being identified, but only eight of them fit the necessary criteria and were accepted to the systematic review. These eight studies contained data on 451 patients, with ages ranging from 15-57. All eight RCTs were reviewed in detail and then assessed for quality.



Pre-operative physical therapy may be valuable to patients having surgery


The RCTs included in the systematic review presented a range of pre-operative physical therapy approaches used, with different lengths, frequencies and the actual content of treatment. Despite this range, the review found that these treatments improved overall outcomes for patients with ACL injuries. This was mainly based on the fact that pre-operative physical therapy led to significant improvements in patients' muscle strength and knee-related function. These findings show that having a course of physical therapy prior to surgery for an ACL injury may be of value to these patients and lead to a better overall recovery. Patients preparing for ACL reconstruction should, therefore, ask their doctor or surgeon about pre-operative physical therapy if the treatment is not already offered.



-As reported in the February '16 issue of Clinical Rehabilitation

May 11, 2017