Honestly I wont discuss that in a forum. I have treated and diagnosed enough ACL tears to know it. Just do the Lachman test and if it is positive (which it most certainly will be) this is his uncontrolled ROM. You could even look at joint movement with Ultrasound while he is walking and see it clear as day no matter how much you train his muscular status. Every non surgery ACL tear will get arthrosis and most knee training methods include a risk of damaging carthilage and ligaments (including rowing and biking). And telling him to do basic boxing oh my
And if the ts writes "training" he obviously does not mean a rehab programm with which I would not have a problem with but its not the best option. Physical therapy before surgery is to get patient ready for surgery as fast as possible with 1) reduce all swelling, 2) get to full extension and 120° flexion. Then surgery and then a rehab program.
Any other recommendation besides no sports and surgery is counter productive to his long term knee health.
What is your profession?
Speaking of Lachmans, while it has relatively high sensitivity compared to some of the other ones you need to use them all to get a better idea. Lachmans, pivot shift and drawer. With that you still need an MRI confirmation and even then you wont have the entire picture untill athroscopy. You don't call a positive Lachmans a show of increased ROM, as ROM pertains to ostekinematics (flexion, extension so on), rather it's a sign of increased translation as it pertains to the arthrokinematics (translations, glides).
Going back to the point, would you care to elaborate how you'd risk ligament damage by rowing or biking? I don't see how the biomechanical forces would put you in any risk what so ever. OA (athritis), and in turn cartilage degeneration, is a natural occurence, but my guess is that your hypothesis is that the increased instability and joint translation would create secondary OA, which is a valid concern. The issue is that even after ACL reconstruction you are in high risk for secondary OA along with joint space narrowing (
1) and the current literature does not support reconstruction as a means to minimise OA outcomes (
2). The reason is in part that while ACL repair creates stability in the knee, it doesn't help prevent faulty arhtrokinematics (
3), which is why the main priority is the quality of your targeted rehabilition (alignment, biomechanics, neuromuscular control, periarticular strengthening so on) AND controlling other risk factors like diet, weight and lifestyle (
4).
Let's start with discussing conventional (exercise therapy alone) vs surgical interventions. Cochrane did a meta-analysis in 2016 concluding that there was low evidence to suggest that exercise therapy alone had simular outcomes on pain and KOOS (Knee injury and Osteoarthritis Outcome Score) two and five years after injury (
5). Personally I believe it's important to note the nature of the injury, and also consider the patients goals and aspirations. Now, in regards to a prolonged prehabilitation program before ACL reconstruction, The American Journal of Sports Medicine did a recent cohort which showed that patients who recieved extended prehab had better KOOS scores, better function, less pain AND were more likely to return to sport at a 2 year follow up (
6). They conclude that: "
Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR (reconstruction red.)".
The British Journal of Sports Medicine did a simular study last year that showed that patients who had exercise therapy or exercise therapy and then reconstruction had improved outcomes compared to those who had an immediate repair, at a 5-year follow up (
7). They conclude that delaying ACL reconstruction with exercise therapy might improve diagnostic prognosis. They also stress the importance of meniscus tears and other individual factors in making a decision about rehabilitation, to which they note: "T
reatment-dependent differences in prognostic factors for 5-year outcomes may support individualised treatment after acute ACL rupture in young active individuals". It is also a pretty well known fact that pre-operation quadriceps strength and activation effects post-operative function, which is another argument for exercise therapy pre-op (
8,
9,
10).
TS- Sorry to have muddled the water.
1. It depends on the nature of your injury so go get an MRI if you haven't already and confer with your doctor.
2. Go to a physiotherapist and get counseling on what to do next.
