Author(s): ABEL, R., WILKE, C., OFFERHAUS, C., GLOWA, A., HANSEN, N., NIEDERER, D., Institution: GERMAN SPORT UNIVERSITY COLOGNE, Country: GERMANY, Abstract-ID: 1065

INTRODUCTION:
Anterior cruciate ligament (ACL) injuries represent significant life events for athletes and can substantially impair quality of life. Although the preoperative training prior to ACL reconstruction in improving knee function is well-established, its impact on quality of life remains unclear. Therefore, this study evaluated the effectiveness of a guided, preoperative rehabilitation program compared with a non-guided, self-administered home training program in individuals with ACL rupture by examining knee-related quality of life within patients from different sports.
METHODS:
Participants with an unilateral complete ACL rupture, scheduled to an arthroscopic ACL-reconstruction with a hamstrings or quadriceps autograft in >3 weeks after inclusion were included. The participants were investigator-blinded block-randomised using an 1:1 allocation to one of the following groups: intervention group (structured, criteria-based, guided prehabilitation training) or comparator group (non-guided, self-administered home training). After ACL reconstruction, patients of both groups participated in a standard, postoperative rehabilitation program. Knee-related quality of life (KOOS subscale quality of life) was assessed at six specified time points: during the initial anamnesis in the hospital (t1), 1 to 7 days prior to ACL reconstruction (t2), and at 30 (t3), 60 (t4), 90 (t5), and 180 (t6) days postoperatively. The analyses were conducted based on an intention-to-treat basis, linear mixed models for the change scores to t1 were calculated.
RESULTS:
In the 114 enrolled participants (mean age M = 31.03 years, SD = 10.30 years; 47% males, 53% females), the ACL rupture injuries occurred while playing football (37%), while skiing (26%), and during other sports (37%). After study commencement, 59 participants discontinued intervention or withdrew consent during the course of the study. The intervention group (KOOS subscale quality of life t1: mean = 25.55, 95% confidence interval = [24.21 to 26.89]; t2: 36.29, [35.04 to 37.55]) demonstrated a significantly greater improvement from t1 to t2 in quality of life compared to the comparator group (KOOS subscale quality of life t1: 32.24, [30.96 to 33.52]; t2: 36.40, [35.35 to 37.46]) (p=0.022). The interaction (group*time) of the KOOS subscale quality of life reached significance for the change score from t1 to t5 (p = 0.046) and to t6 (p = 0.006).
CONCLUSION:
According to the International Classification of Functioning, Disability and Health (ICF), the primary objective of a therapy is to minimize activity limitations, enhance participation in social and work-related life, and improve patients’ quality of life. An individually tailored, adaptive, guided and criteria-based preoperative rehabilitation program demonstrates superior improvements in knee-related quality of life compared with self-administered training. Therefore, supervised preoperative exercise can be recommended before an ACL reconstruction, also in terms of improving quality of life.