Functional Outcome of ACL Reconstruction Following Pre-reconstruction Rehabilitation vs. None Rehabilitation: A Systematic Review and Meta-analysis

Aryana, I Gusti Ngurah Wien; Febyan, Febyan; Dimitri, Dominicus; Limena, Shianita; Kuswara, Leonardus William

doi:10.1055/s-0044-1779327

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Systematic Review and Meta-analysis • Rev bras ortop 59 (2) • 2024 • https://doi.org/10.1055/s-0044-1779327 copy

Functional Outcome of ACL Reconstruction Following Pre-reconstruction Rehabilitation vs. None Rehabilitation: A Systematic Review and Meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The aim of this study is to analyse the needs for pre-operative rehabilitation in patients undergoing ACL reconstruction.

Methods

The database reports were searched within 2018 to 2023, using PubMed, Cochrane library database, Medline, and other published trials. A statistical analysis was made from Review Manager.

Results

Pre-operative rehabilitation group shows significantly higher 2 years post-operative KOOS score in all subscore and the total mean of the score, pain (p < 0. 0001), symptoms (p < 0. 0001), ADL (p < 0. 0001), sports and recreations (p < 0. 0001), QoL (p < 0. 0001), and the total mean of the KOOS score (p < 0.0001). In contrary, pre-operative rehabilitation group shows insignificantly higher score on 3 months post-operative Lysholm score (p = 0.12).

Conclusion

This meta-analysis conclude pre-operative rehabilitation may provide better long-term post-operative outcome, however it may not provide much of a short-term outcome. It is recommended to add pre-operative rehabilitation as a guideline for ACL injury management to improve long-term outcome of patients with ACL injury undergoing ACL reconstruction procedure.

Keywords
anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; pre-operative rehabilitation

	Inclusion criteria	Exclusion criteria
Population	• Age 18-40 • Planned for reconstructive surgery • Attending pre-operative rehabilitation	• Age < 18 or >40 • Acute ACL tear • Complex injury
Intervention	Pre-reconstruction rehabilitation program.	• Patients undergo conservative treatment
Control	Only post-operative rehabilitation No rehabilitation program
Outcome	• KOOS score • Lysholm score	• Outcome measures not reported in completion. • Outcome measures only report the difference. • Outcome measures collected at different. • Outcome measures are not comparable to one another
Design	Randomized Controlled Trial, Cohort, Case Series	Case Report, Systematic Review, Meta-analysis

No	Author (year)	Journal	Studi Design	Level of Evidence
1	Amaravati et al. (2013)¹⁰10 Amaravati R, Sekaran P. Does preoperative exercise influence the outcome of ACL reconstruction? Arthroscopy 2013;29(10): e182-e183	ISAKOS	Single blind prospective RCT	2a
2	Failla et al. (2016)⁵5 Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. [published correction appears in AmJ Sports Med 2017 Apr;45(5):NP9]Am J Sports Med 2016;44(10):2608-2614	American Journal of Sports Medicine	Cohort	3
3	Grindem et al. (2015)⁹9 Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 2015;49(06):385-389	British Journal of Sports Medicine	Cohort	2a
4	Reddy et al. (2020) ¹¹11 Reddy D, Kamath S, Annappa R, Krishnamurthy S, Kamath K, Mallya S. Does preoperative rehabilitation give better short term results in anterior cruciate ligament reconstruction? Ambul Surg 2020;26(02):40-43	Ambulatory Surgery	prospective randomised study	2a
5	Aiyanna, et al. (2022)¹²12 Aiyanna K, Bijarniya S, Sharma A. The effect of preoperative rehabilitation on the outcome of ACL reconstruction. Int J Recent Sci Res 2022;13(04):1012-1016	International Journal of Recent Scientific Research	Prospective study	2a

No	Author (year)	Intervention	Control	Sample size (n)	Gender (Male/Female)	Age (years)	Follow-up (months)
1	Amaravati et al. (2013)¹⁰10 Amaravati R, Sekaran P. Does preoperative exercise influence the outcome of ACL reconstruction? Arthroscopy 2013;29(10): e182-e183	R	NR	I: 32	NA	NA	ROM: 6w, 3m, 6m, 1y
1		R	NR	C: 31	NA	NA	Pain, Grith, Lysholm, Tegner activity, LEFS, IKDC, Hop test
2	Failla et al. (2016)⁵5 Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. [published correction appears in AmJ Sports Med 2017 Apr;45(5):NP9]Am J Sports Med 2016;44(10):2608-2614	R	NR	I: 192	Male 55%	24,3 ± 10	IKDC and KOOS pre and 2 years post
2		R	NR	C: 1995	Male 55%	24,3 ± 10	IKDC and KOOS pre and 2 years post
3	Grindem et al. (2015)⁹9 Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 2015;49(06):385-389	R	NR	I: 84	Male 54%	24,7 ± 9	KOOS pre op (post rehab), 2 years post op
3		R	NR	C: 2690	Male 54%	24,7 ± 9	KOOS pre op (post rehab), 2 years post op
4	Reddy et al. (2020)¹¹11 Reddy D, Kamath S, Annappa R, Krishnamurthy S, Kamath K, Mallya S. Does preoperative rehabilitation give better short term results in anterior cruciate ligament reconstruction? Ambul Surg 2020;26(02):40-43	R	NR	I: 20	M: 38	I 27,48	IKDC Grade, Lysholm, ROM pre, 3w, 6w, 3M,6M post op
4		R	NR	C: 21	F: 3	C 28,17	IKDC Grade, Lysholm, ROM pre, 3w, 6w, 3M,6M post op
5	Aiyanna, et al. (2022)¹²12 Aiyanna K, Bijarniya S, Sharma A. The effect of preoperative rehabilitation on the outcome of ACL reconstruction. Int J Recent Sci Res 2022;13(04):1012-1016	R	NR	I: 15	M: 25	0-20: (27%)20-40: (67%)40-60 (6%)	IKDC, KOOS, Lysholm score3, 6, and 12 months
5		R	NR	C: 15	F: 5	0-20: (27%)20-40: (67%)40-60 (6%)	IKDC, KOOS, Lysholm score3, 6, and 12 months

No	Author (year)	Conclusion	Group (N)	Period of Rehab	KOOS Mean	KOOS Pain	KOOS Symptoms	KOOS ADL	KOOS Sports	KOOS QOL	Lysholm Score
1	Amaravati et al. (2013)¹⁰10 Amaravati R, Sekaran P. Does preoperative exercise influence the outcome of ACL reconstruction? Arthroscopy 2013;29(10): e182-e183	Pre op Exercise resulted in better Post op functional outcomes at the long term	I (32)	3W	NA	NA	NA	NA	NA	NA	95,5 (3,4)
1			C (31)	NA	NA	NA	NA	NA	NA	NA	89,32 (5,6)
2	Failla et al. (2016)⁵5 Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. [published correction appears in AmJ Sports Med 2017 Apr;45(5):NP9]Am J Sports Med 2016;44(10):2608-2614	Preoperative rehabilitation (progressive strengthening and neuromuscular training) had greater functional outcomes and RTS rates 2 years after ACLR	I	NA	88,52	94 (10)	89 (12)	98 (5)	85,6 (18)	76 (20)	NA
2			C	NA	73,32	78 (33)	72 (32)	82 (34)	70,6 (33)	64 (32)	NA
3	Grindem et al. (2015)⁹9 Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 2015;49(06):385-389	Progressive pre operative rehab showed superior patient reported outcomes at 2 years postoperatively	I	6M	88,88	93,5 (10,3)	89,2 (11,9)	98 (5,6)	85,1 (16,2)	78,6 (20,4)	NA
3			C	NA	78,24	86 (15,1)	77,4 (18)	92,5 (12,8)	67,6 (25,9)	67,7 (22,7)	NA
4	Reddy et al. (2020)¹¹11 Reddy D, Kamath S, Annappa R, Krishnamurthy S, Kamath K, Mallya S. Does preoperative rehabilitation give better short term results in anterior cruciate ligament reconstruction? Ambul Surg 2020;26(02):40-43	Pre op rehab improve early functional outcome at 3 weeks and 6 weeks	I (20)	3W	NA	NA	NA	NA	NA	NA	93,86
4			C (21)	NA	NA	NA	NA	NA	NA	NA	92,43
5	Aiyanna, et al. (2022)¹²12 Aiyanna K, Bijarniya S, Sharma A. The effect of preoperative rehabilitation on the outcome of ACL reconstruction. Int J Recent Sci Res 2022;13(04):1012-1016	Pre op rehab enhance post op outcome as measured up to 1 year.	I (15)	3M	91,87	NA	NA	NA	NA	NA	NA
5			C (15)	NA	78,67	NA	NA	NA	NA	NA	NA

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence I Gusti Ngurah Wien Aryana, Dr; dr; Sp. OT(K), Sport Medicine, Department of Orthopaedic & Traumatology, Prof Ngoerah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia (e-mail: wienaryanaortho@gmail.com).