The Benefits of Pre-Op Physical Therapy for ACL Tears

You've injured your knee playing sports, and you visited your orthopedic surgeon who ordered an MRI of your knee. The results come back: anterior cruciate ligament (ACL) tear, and your doctor recommends surgery to repair it. What should you do to prepare for surgery? For one, you should go see your physical therapist for pre-op ACL therapy.

Research indicates that pre-operative physical therapy—PT before you have an ACL repair—may help improve overall functional outcomes after your ACL surgery.

Physical therapist working with client at gym

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Physical Therapy for Your ACL

Your ACL helps to support your knee by preventing forward slippage of your shin bone underneath your thigh. An ACL sprain can occur when you twist your knee suddenly, usually while your foot is planted on the ground. This may happen when cutting and running fast or while jumping and landing.

Signs and symptoms of an ACL sprain may include:

  • Knee pain
  • Swelling in your knee
  • Difficulty bending or fully straightening your knee
  • Feeling of knee instability

If you suspect you have an ACL tear, you should go to see your doctor to get an accurate diagnosis and to devise an appropriate treatment strategy for your specific condition. Your doctor can perform special tests to see if your ACL is torn, and an MRI may be used to confirm the suspected diagnosis. Treatment for an ACL tear may be conservative, consisting of physical therapy and exercise, or it may be more invasive, consisting of a surgical repair of your anterior cruciate ligament.

Not everyone who has an ACL tear requires surgery. Many people are able to fully function with a torn ACL; the ligament simply heals and your knee range of motion (ROM) and leg strength fully return. The problem is that high-intensity activities and sports may become difficult, especially if the sport requires you to jump and land or to engage in cutting and changing directions rapidly while running.

In these cases, your ACL-deficient knee may not be able to handle the forces that are placed upon it while participating in these activities. People who wish to return to high-level sports may choose to have a surgical repair of their ACL. Your doctor can help you decide on the best treatment for you.

Components of a Pre-Op ACL PT Program

If you have an ACL tear and are facing surgery, you should ask your doctor if you can engage in a pre-operative physical therapy program. Your PT can assess your condition and prescribe the right exercises to help you improve your ROM, strength, and overall mobility prior to surgery.

Components of a physical therapy prehab program prior to ACL surgery may include:

  • Exercises to improve knee ROM
  • Exercises to improve quadriceps and hamstring strength
  • Balance and proprioception exercises
  • Neuromuscular electrical stimulation (NMES) to improve quadriceps function
  • Treatments to control knee joint swelling
  • Neuromuscular training, which includes learning to jump and land properly and to stabilize your knee while participating in high-level sports and activities.

The main goal of pre-operative ACL PT is to restore maximal knee ROM, strength, and stability so that you are prepared to undergo ACL repair surgery and have the best possible outcome. But is pre-op therapy really worth it?

What the Research Shows

When considering physical therapy prior to ACL surgery, you should have a basic understanding of what the published research indicates. It can help guide your decision-making process when deciding to attend pre-op PT or not.

A study published in the American Journal of Sports Medicine examined the long-term effects and functional outcomes from patients who underwent pre-op ACL rehab and those who did not attend PT prior to their ACL repair surgery. The researchers found that patients who participated in physical therapy prior to their ACL surgery had a greater return to sports rate and improved scores on specific knee outcomes measures.

These benefits lasted for over 2 years after surgery. The patients who participated in pre-op ACL rehab, or prehab, had better functional outcomes with their knee. Simply put, 2 years after surgery, patients who did PT before ACL surgery were better off than those who did not participate in pre-op physical therapy.

Another study found that patients who participated in pre-operative physical therapy had better single leg hop testing results 12 weeks after their ACL repair surgery. The single-leg hop test is a recognized tool to measure an athlete's readiness to return to the sport after ACL surgery. Patients who participated in the study also had better scores on knee outcomes measures when compared to patients who did not participate in pre-op PT.

These studies may lead you to conclude that greater benefits can be had if one participates in physical therapy prior to undergoing surgery for a torn ACL.

Putting It All Together

Why would you consider pre-op physical therapy before an ACL surgery? Isn't your knee going to suffer from swelling, pain, and loss of mobility as a result of the surgery? Will all pre-op gains be lost after the surgery?

Maybe so. But research shows that working on your knee ROM, strength, and neuromuscular control prior to surgery yields positive long-term outcomes. Taking time to maximize your knee mobility prior to your surgery can possibly lead to improved outcomes after your surgery. Remember that everyone is different, and everyone's injury and needs differ. Understanding the possible benefits of pre-op PT before your ACL surgery can help you make the best choice for your specific condition.

If you have torn your ACL in your knee, you should speak with your doctor to come up with a plan of care that is right for you. Some people do not require surgery for their torn ACL. Other people may need surgery—followed by post-operative ACL rehab—to maximize their functional mobility after their injury.

Engaging in a physical therapy program that focuses on improving knee mobility and muscular control can have benefits that last into the postoperative period. It is a good idea to talk to your doctor or surgeon and ask if pre-operative physical therapy for your ACL tear is the right course of action for your specific condition.

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  • Failla, MJ, etal. 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 Oct; 44(10): 2608-2614.
  • Shaarani, SR, etal. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. AM J Sports Med. 2013 Sep; 41(9):2117-27.