The Effect of Prehabilitation on the Self-Reported Outcomes of Anterior Cruciate Ligament Reconstruction: A Systematic Review Running Title:

Background and Purpose: Quadriceps weakness and disruption of proprioceptive function are common after anterior cruciate ligament (ACL) injury and consequently the surgery. Postoperative self-reported outcomes are affected by the preoperative defect. The purpose of this review study was to examine whether preoperative exercises can affect self-reported outcomes. Methods: The study started searching for papers from the PubMed, Scopus, EMBASE, Cochrane, and Web of Sciences databases and extracted the entered studies from 1990 to 2020. Moreover, the terms “ACL preoperative exercise” or “prehabilitation ACL” and “self-reported outcomes” or “postoperative outcomes” were used in the search titles, where 906 papers were finally found. Then, according to the main topic of the present study, and the inclusion and exclusion criteria, 10 papers met the inclusion criteria of the review. The methodological quality of the studies was also assessed through the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP). Results: The presentation of several preoperative intervention programs (traditional, strength, and neuromuscular training) significantly enhanced self-reported knee function in men and women after surgery in the short and long-term. The mean PEDro score for seven randomized controlled trial studies was found to be 6.3, which showed the moderate quality of the methodology. Moreover, the score for three cohort studies using the CASP scale was 7 out of 12. Conclusion: Preoperative rehabilitation consisting of progressive strengthening and neuromuscular training, followed by a criterion-based postoperative rehabilitation program, had greater functional outcomes after Anterior Cruciate ligament reconstruction. Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR.