Does preoperative anterior cruciate ligament rehabilitation produce superior outcomes before and after reconstructive surgery compared to current care

Patients who satisfy eligibility criteria of a primary unilateral anterior cruciate ligament (ACL) rupture awaiting surgery are referred by their Surgeon to consider participation in preoperative rehabilitation. After undergoing baseline testing consisting of validated isokinetic strength testing of the quadriceps, hop tests (6m and maximal distance), and self-reported scales (KOOS, Tegner, Marx) consented participants are randomised into either the intervention (Group 1) or current care (Group 2) cohort. The intervention cohort complete a 6-week supervised preoperative rehabilitation protocol, and Group 2 continue with their usual care and preparation for 6 weeks while awaiting surgical reconstruction. The intervention methodology consists of progressive overloading exercise focused on quadriceps strength, and is delivered by a specifically qualified physiotherapist twice per week. After completing the respective 6 week preoperative phases participants are re-tested, and then undergo ACL reconstruction. All participants can receive post-operative rehabilitation as guided by their Surgeon and return for final assessment 12 weeks post-surgically. Post-operative rehabilitation is unrestricted over the 12-week reassessment timeframe as evidence suggests that irrespective of the type of post-operative rehabilitation protocol the critical success factor up to 2 years post surgically is preoperative rehabilitation aimed at optimising quadriceps strength. Therefore, the study design is confined to examining the effectiveness of preoperative rehabilitation, and no constraints or control over post-operative rehabilitation has been given. After the final assessment, a small number of selected participants from each cohort will be interviewed using a written series of questions related to the experience of undergoing rehabilitation for their ACL injury.