Authors (including presenting author) :
Tong KC(1), Cheng CW(1), Au TK(1), Fung YK(1), Ngan KT(1), Li CW(1), Yiu L(2), Yuen SH(2)
Affiliation :
(1)Physiotherapy Department, Tseung Kwan O Hospital
(2)Department of Orthopedics and Traumatology, Tseung Kwan O Hospital
Introduction :
Preoperative quadriceps strength is a strong predictor for functional outcome after ACLR, while preoperative range of motion(ROM) deficit and uncontrolled knee inflammation related to the occurrence of arthrofibrosis.
ERAS evidence revealed physiotherapy prehabilitation can prevent major complications of ACLR, including persistence muscle weakness or postoperative arthrofibrosis. Hence, studies suggested recovery can be enhanced, when the injured knee quadriceps strength achieves at least 80% of the unaffected side and without ROM deficit perioperatively.
A new ACLR-prehabilitation program, which combined education and physical optimization were implemented since September/2019, aiming to improve preoperative physical condition and function, avoid surgery delay, enhance postoperative recovery and facilitate safety discharge.
Objectives :
(1)To implement the prehabilitation model for ACLR;
(2)To evaluate the program effectiveness and functional outcomes.
Methodology :
Patients scheduled for ACLR were recruited for a 6-8weeks ACLR-prehabilitation program before surgery. This program included inflammation control, joint mobilization, gradual loaded strengthening and neuromuscular training, early post-operative self-management techniques, walking aids prescription and training.
Outcomes included:
1)Perioperative and postoperative pain level by Visual Analogue Scale(VAS);
2)Perioperative and postoperative ROM of injured knee joint;
3)Perioperative between limbs quadriceps strength difference at 60degrees/sec;
4)Postoperative length-of-stay and complication rate.
Result & Outcome :
Thirteen patients(Female:46.1%; mean age:26.3., range:18-45; Body Mass Index< 30kg/m2) who attended and completed the ACLR-prehabilitation program in 2020 were reviewed.
After prehabilitation, their injured knee’s pain was significantly reduced(p=0.016) and the ROM was fully regained(Flexion:122±14.2degrees to full, p=0.001; Extension:5.4±4.8degrees to full, p=0.002). Seventy-seven per-cent patients’ between limbs quadriceps strength deficit were less than 20%. The postoperative outcomes of all patients were compared with another twelve randomly recruited patients(Female:25%; mean age:30.8., range:23-45; Body Mass Index< 30kg/m2) who underwent ACLR without prehabilitation in 2020. Although no significant difference in ROM was noted in the injured knee at postoperative week sixth and twelfth, the ACLR-prehabilitaiton group, however, had significantly lower pain level(p=0.031 & 0.01).
Besides, more than 90% of patients were highly satisfied with the ACLR-prehabilitation program and they have received surgery on schedule at the time of review. No one has suffered from any post-operative complication(arthrofibrosis, deep vein thrombosis, etc.) and were safely discharged within 2days.
These results supported physiotherapist led ACLR-prehabilitation program was effective to achieve pre-operative goals to ensure patients undergo operation on schedule, minimize complication and enhance post-operative recovery to facilitate the early discharge safely.
Study on the benefit of long term rehabilitation outcomes with the presence of prehabilitation will be reviewed in the future.
