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Why Prehab is important before Knee Ligament surgery?

By Luqman Shaikh – Sports Scientist – Founder Prehab 121

A torn knee ligament is a common sports injury that often happens during activities that involve sudden stops, jumping or changes in direction, such as basketball, soccer, football, tennis, downhill skiing, volleyball and gymnastics. The time period after a confirmed knee ligament tear and prior to surgery is an important one. During this time, you have an opportunity to prepare your knee and body for surgery, minimize the effect of your injury, and prepare for successful recovery and rehabilitation after knee surgery.

In some cases, physiotherapy alone may be enough to ease the symptoms of a partially torn ligament, as well as strengthen the muscles around it and restore the knee's range of motion. But surgery to reconstruct the knee ligament is typically recommended for athletes who want to continue playing sports, as well as for patients who are young and active. Surgery also may be necessary if the injury consistently causes significant instability in the knee joint.

Research shows that prehabiltation can offer significant advantages, especially for athletes who want to return to playing sports after the surgery. Physiotherapy before surgery is referred to as prehabilitation. Prehabilitation has been defined as “the process of enhancing functional capacity of the individual to enable them to withstand the stressor of inactivity”, preparing a patient before a stressful event.(1) Its goal is to strengthen the muscle groups in the affected leg in order to increase the chances of a better functional outcome after knee ligament surgery.

Physiotherapy is a crucial component of treatment for a knee ligament injury. Both before and after surgery, working with a physiotherapist who has expertise and experience helping patients who have torn their knee ligament can make a significant difference in the amount of time it takes to recover from this injury.

A study by Rudolph et al looked at two groups of patients who had a torn Anterior Cruciate Ligament (ACL). One group participated in a physiotherapy program that involved exercising 4 days a week for 6 weeks before having surgery to reconstruct the ACL. The other group did not participate in a physical therapy program prior to the surgery. The study results found substantial improvement in functional outcomes 12 weeks after surgery in the group who completed the physical therapy program before they had surgery. For example, the exercise group outperformed the non-exercise group in the single-leg hop test — a physical evaluation tool that's often used to help guide return-to-sports decisions after ACL injuries. There also was a sizable difference in how long it took the two groups to return to their sports after the surgery. In the exercise group, the average was 34.2 weeks, compared to 42.5 weeks in the group that did not exercise before surgery. These results support the conclusion that physiotherapy prior to ACL surgery can be beneficial to the recovery process.(2)

Another study by Keays et al showed that 5-week prehab strategy that included progressive muscle strengthening has been shown to significantly improve knee function, quadriceps peak torque, torque at 30 degrees of flexion, and total work in patients with ACL injury. (3)

Prehab also helps in improving proprioception. Beard et al compared the effects of proprioceptive versus traditional exercise regime in ACL deficient patients prior to surgery. The program consisted of 2 gym session combined with daily self-supervised home physiotherapy. Patients subjected to proprioception regime had significant better functionality. (4)

Therefore, the role of prehab as a pre-operative intervention should be incorporated with resistance training in combination with proprioceptive training to significantly improve their overall leg strength prior to surgery.


1. M. M. Ditmyer, R. Topp, and M. Pifer, “Prehabilitation in preparation for orthopaedic surgery,” Orthopaedic Nursing, vol. 21, no. 5, pp. 43–52, 2002.

2. K. S. Rudolph, M. E. Eastlack, M. J. Axe, and L. SnyderMackler, “Movement patterns after anterior cruciate ligament injury: a comparison of patients who compensate well for the injuryand those who require operative stabilization,” Journal of Electromyography and Kinesiology, vol. 8, no. 6, pp. 349–362, 1998.

3. S. L. Keays, J. Bullock-Saxton, and A. C. Keays, “Strength and function before and after anterior cruciate ligament reconstruction,” Clinical Orthopaedics and Related Research, no. 373, pp. 174–183, 2000.

4. D. J. Beard, C. A. F. Dodd, H. R. Trindle, and A. H. R. W. Simpson, “Proprioception enhancement for anterior cruciate ligament deficiency. A prospective randomised trial of two physiotherapy regimes,” Journal of Bone and Joint Surgery— Series B, vol. 76, no. 4, pp. 654–659, 1994.


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