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


To evaluate the effectiveness of preoperative rehabilitation (PreHab) on postoperative outcomes, including psychological outcomes following anterior cruciate ligament reconstruction (ACLR).


The systematic review was reported following the PRISMA statement and was registered with PROSPERO: 2020CRD42020162754. An electronic database search was conducted in CINAHL, AMED, PsycINFO, Medline and SPORTDiscus via EBSCOhost and Web of Science from inception to November 2019. Hand searches of reference lists of included articles were also searched in addition to the grey literature via OpenGrey, and WHO International Clinical Trials Registry Platform. 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 included exercise programmes that 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. One RCT reported no statistically significant between-group difference for pain and function. The PreHab intervention in all three RCTs was an exercise programme. No RCT evaluated post-operative psychological outcomes.

Conclusion(s): Low-quality evidence suggests that PreHab including muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores 3-months after ACLR. There is no consensus on the optimum PreHab programme content, frequency and length; this requires future consideration including the development of PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness.

Cost and savings

No further data 


The three included RCTs offer unconvincing results on post-operative outcomes of muscular strength, function and patient reported symptoms of pain and function. Future research could look to evaluate holistic interventions that consider the physical and psychological state of individuals and how this may affect post-operative outcomes.

Top three learning points

No further data 

Funding acknowledgements

This review was completed as part of the ICA Internship funded by HEE/NIHR working in the East Midlands