Late-stage rehabilitation after anterior cruciate ligament reconstruction: A multicentre randomised controlled trial (PReP).

After finishing standard rehabilitation following anterior cruciate ligament (ACL) reconstruction, many people still haven't regained full functional capacity, raising the question of whether extra late-stage training helps. This trial compared a 5-month structured neuromuscular programme, called Stop-X, with usual care (standard physiotherapy, individualised rehabilitation, and home exercises) in 112 young adults who had already completed formal rehabilitation. On the main measure, a landing movement pattern thought to reflect injury risk, there was no statistically significant difference between groups. However, several patient-reported outcomes, including knee pain, sport-related problems, confidence to return to sport, and daily activity ability, showed improvements favoring the programme group at certain time points, along with better symmetry in a hop test later on.

More people in the programme group returned to their pre-injury sport. The authors describe the benefit as small, and because this is one trial with modest numbers, the findings should be seen as preliminary rather than conclusive.

If you've finished your formal ACL reconstruction rehabilitation but still don't feel fully back to your old sporting self, this is a familiar situation, and it's one many people face even after completing standard physiotherapy. This study tested whether an extra 5-month structured exercise programme, done after finishing regular rehab, could help more than continuing with usual care alone (standard physiotherapy, individualised exercises, and home exercises). The main test, a jump-landing measurement, didn't show a clear difference between the two groups.

But people doing the extra programme reported less knee pain, fewer sport-related problems, and more confidence about returning to sport at some points during the study, and more of them (79 percent versus 70 percent) ended up back at their pre-injury sport type and level. This is encouraging but comes from a single, fairly small trial, so the benefit is described as modest rather than dramatic, and it's not yet clear how reliable or lasting these improvements are.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses a practical question many clinicians face: once formal ACL reconstruction rehabilitation ends, is there value in continuing a structured late-stage neuromuscular programme rather than relying on usual care (standard physiotherapy, individualised rehabilitation, home exercises)? In this multicentre, double-blind, randomised trial of 112 analysed participants (57 Stop-X, 55 usual care), aged 18 to 35 and roughly 8 months post-reconstruction, a 5-month programme was compared against usual care across monthly assessments. The primary outcome, normalised knee separation distance on drop-jump landing, showed no statistically significant between-group*time effect, meaning no clear advantage was detected on this biomechanical marker. Several secondary outcomes did favor the intervention group at specific timepoints: KOOS-SPORT, ACL-RSI confidence, KOOS-PAIN, and KOOS-ADL improved at 2 months, and limb symmetry index on a hop-for-distance test improved at 3 and 4 months, with confidence intervals reported for each.

Kinesiophobia, symptom-related knee problems, and balance hop performance showed no between-group effects. Return to pre-injury sport was significantly higher with Stop-X (79% vs 70%, p<0.05), though this was a secondary finding.

The authors characterise the overall benefit as slight, and given this is a single trial with a modest sample, these findings should inform rather than settle expectations about late-stage rehabilitation value; they do not establish that the programme altered injury-relevant biomechanics or long-term outcomes.