Rehab & Prehab Protocols — ACL & Knee Replacement
Prehabilitation (before surgery) and structured rehabilitation (after surgery) are central to how we achieve reliable results. For soft-tissue procedures (for example, ACL reconstruction), we aim for full knee extension, near-full flexion, and good quadriceps activation/strength before operating. Evidence suggests that prehab can improve early strength and hop performance after ACLR, and expert guidance emphasises restoring ROM and settling effusion pre-op to lower arthrofibrosis risk.
For knee replacement (UKR/TKR), the principle is similar: arrive strong, leave stronger — better pre-op mobility and strength support smoother early recovery. Contemporary reviews of prehabilitation for TKA and UK guidance stress the role of structured physio and early mobilisation after surgery.
Surgery is a controlled trauma: swelling, pain, and reflex inhibition will temporarily switch off muscle. A good prehab base and committed post-op rehab are what convert surgery into function. Skipping rehab is linked with stiffness, weakness and poorer function; national guidance recommends prompt, structured physiotherapy.
Goals Before Surgery (Prehab)
ACL / soft-tissue procedures
- Settle effusion, regain full extension, flexion as close to normal as comfortable
- Quadriceps activation (straight-leg raise without lag), symmetrical gait with or without aids
- Foundational strength: early closed-chain patterns and balance/proprioception
- Criteria-based readiness helps reduce stiffness risk after ACLR
Knee replacement (UKR/TKR)
- Aim for full extension, best attainable flexion, and basic functional strength (sit-to-stand, step work)
- Education on swelling control, sleep, pacing; home set-up for safe mobility
- Evidence on TKA prehab is mixed but supports early post-op function and shorter LOS in several analyses; all guidelines support early, structured rehab
What Rehab Looks Like (High-Level)
After ACL reconstruction (with or without meniscus/LET)
- Phase 1 (Weeks 0–2): protect graft/repairs, full extension, flexion 0–90° if allowed, quad activation, gait with aids
- Phase 2 (Weeks 2–6): controlled ROM to 110–120°, closed-chain strength, balance, bike
- Phase 3 (Weeks 6–12): strength and mechanics; consider return-to-run 10–14+ weeks only if criteria met (no effusion, good control, strength)
- Phase 4–6 (Months 3–12): agility, power, change-of-direction; return to sport when objective tests (strength/hop/quality) meet targets, usually more towards 12 months
Active rehabilitation is highlighted in multiple ACL clinical practice guidelines.
After knee replacement (UKR/TKR)
- Day 0–1: mobilise with physio (enhanced recovery)
- Weeks 1–6: normalise gait, ROM towards 0–110°+, progressive strength, bike
- Weeks 6–12: endurance, stair confidence, community walking unaided
- Months 3–6+: return to preferred low-impact activities
NICE guidance supports same-day/next-day mobilisation and structured post-op rehab.
Why Your Participation Matters
- What you put in affects what you get out
- If you do not do the physiotherapy before the surgery, it is unlikely you will do it afterwards
- If your knee is moving poorly before the surgery, it is likely your outcome will be poor - Mr Nahas will assess and explain this to you where necessary
How We Embed This in Reading
- Self-pay consultations within a week and imaging within ~7 days at Circle Reading Hospital
- Clear, written home programmes and criteria-based milestones
- Close liaison with local physiotherapists across Reading, Berkshire, Wokingham, Henley, Oxford, Newbury, Maidenhead, Bracknell, Basingstoke, High Wycombe, Slough, Windsor, Ascot, Marlow and Didcot
- For surgery, you will complete pre-assessment and a 5-day antibacterial wash protocol, then follow a structured, evidence-based rehab plan