Optimizing surgical readiness and recovery in anterior cruciate ligament reconstruction: A narrative review

Background and Aims: Anterior cruciate ligament (ACL) injury is a common sports-related knee injury that may cause instability, meniscal damage, chondral injury, and impaired return to activity when inadequately treated. This narrative review summarizes clinically relevant pre-operative and post- operative preparation for ACL reconstruction, with emphasis on surgical readiness, graft-related rehabilitation considerations, and criterion-based recovery. Materials and Methods: Relevant clinical reviews, consensus statements, cohort studies, randomized studies, systematic reviews, and rehabilitation guidelines were narratively reviewed and organized into themes of ACL injury, reconstruction, prehabilitation, post-operative rehabilitation, graft selection, and return-to-sport decision-making. Results: Optimal pre-operative preparation includes effusion control, restoration of full active and passive range of motion, especially full extension, quadriceps activation, strength symmetry, neuromuscular control, and psychological readiness. Post-operative rehabilitation should progress from protection and motion restoration to endurance, strength, power, agility, and sport-specific training using objective criteria rather than time alone. Conclusion: ACL reconstruction outcomes are optimized through individualized graft selection, a quiet knee before surgery, progressive criterion-based rehabilitation, objective strength and functional testing, and coordinated decision-making among the surgeon, rehabilitation clinician, and patient.