Objectives: Although the effectiveness of preoperative trainings prior to an ACL reconstruction is well established, no clear consensus regarding the specific content, optimal supervision (one-on-one guidance or self-administered training) and the overall framework remains. This study aimed to compare the effectiveness of an individually tailored, guided, structured, and criteria-based preoperative rehabilitation program (IG) with a non-guided, structured, self-administered home training program (CG) in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods: In this assessor-blinded RCT, individuals aged 16–60 years with a unilateral ACL rupture and scheduled for ACL reconstruction using hamstring or quadriceps tendon autografts were 1:1 block-randomized into IG or CG. The primary outcome was self-reported knee function (KOOS sum score), assessed alongside functional and subjective outcomes at seven time points from anamnesis to 180 days post-surgery. Linear mixed models were used to analyze change scores (intention-to-treat). Results: Among 114 participants (mean age 31.0 ± 10.3 years; 53% female), 58 dropped out or discontinued the intervention. Both groups improved preoperatively, but the IG showed a significantly greater KOOS improvement from anamnesis to the day of surgery (IG: 46.04 → 58.52; CG: 51.01 → 59.18), with a significant group*time interaction (p = 0.039). This difference persisted up to 60 days postoperative (p = 0.039), though overall effect sizes were small. Conclusion: An individually tailored, supervised prehabilitation program resulted in superior improvements in perceived knee function compared to a self-administered program. These findings highlight the importance of guidance and adaptive progression in prehabilitation, offering valuable insights for optimizing rehabilitation strategies before ACL reconstruction.
Offerhaus et al. (Wed,) studied this question.