How Do Patients Benefit From Pre-Op Rehab?

Pre-operative rehabilitation (pre-op rehab) has been a key part of the Shelbourne Knee Center system for optimizing surgical outcomes and helping patients return to the field and/or their lives since 1989. Most patients with knee osteoarthritis (OA) improve enough through pre-op rehab that they no longer need surgery.

Better Outcomes

“When we see patients with knee problems, their goal is to get back to normal,” says K. Donald Shelbourne, MD, orthopaedic surgeon and founder of Shelbourne Knee Center. “My job has been to figure out how to help patients get that result.”

Dr. Shelbourne changed his rehabilitation protocol to include pre-op rehab after research on his ACL reconstruction patients showed the importance of full range of motion (ROM) and returning the knee to a normal state (except for the ACL tear) to speed up recovery time and allow patients to more easily achieve their goals (1). One key finding is that patients who had surgery within a week of an acute ACL tear had a much higher rate of ROM problems after surgery than those who waited at least 21 days to undergo pre-op rehab (2).

“If patients don’t have full ROM in the knee prior to surgery, the ability to get full ROM back after surgery is compromised,” says Dr. Shelbourne.

Treatment and Guidance

To support the pre-op rehab program, Shelbourne Knee Center currently has seven physical therapists and one athletic trainer on staff, and an on-site gym. Pre-op rehab starts with work to improve ROM in the knee, focusing first on extension and then on flexion. Only when the patient has achieved sufficient ROM does strengthening begin.

Surgery is delayed to obtain:

  • Full ROM.
  • Little or no swelling.
  • Normal walking.
  • Appropriate strength and leg control.

Borrowing a concept from oncology and transplants, physical therapists and the athletic trainer also serve as patient navigators. “The same person takes care of the patient before and after surgery,” says Dr. Shelbourne. “It’s part of our process of making sure things go well.”

The physical therapists and athletic trainer provide guidance through the entire process, including:

  • Educating patients about their role in a good outcome.
  • Preparing patients mentally, emotionally, physically and socially for surgery.
  • Coaching patients through pre-op and post-op rehab.

Customized Rehab.

Each patient receives a customized, research-based rehab program. With guidance from a physical therapist or athletic trainer, patients complete the pre-op rehab at home, with periodic visits to Shelbourne Knee Center.

Surgery, when necessary, is scheduled when two conditions have been met:

  1. The knee has returned to as normal a state as possible with rehab.

Specialized Rehab Expertise

Shelbourne Knee Center is the only orthopedic practice with physical therapists and athletic trainers who are highly-trained in—and only focus on—the knee. Dr. Shelbourne and Orthopaedic Surgeon Rodney Benner, MD, personally train each physical therapist and athletic trainer on their staff. All physical therapists and athletic trainers are involved in the practice’s research and in developing rehabilitation protocols.

For more information about our pre-op rehab program, please call 888-FIX-KNEE.


  1. Biggs A, et al. Rehabilitation for patients following ACL reconstruction: A knee symmetry model. North Am J Sports Phys Ther. 2009;4:2-12.
  2. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Athrofibrosis in Acute Anterior Cruciate Ligament Reconstruction. The Effect of Timing of Reconstruction and RehabilitationAm J Sports Med. 1991;19:332-336.