Prehabilitation (of Anterior Cruciate Ligament Rupture) - is It Cost-Effective?

Background Musculoskeletal injuries are common in sports. If musculoskeletal injuries in professional sports require treatment, not only the professional athlete (patient) but also the service providers (physicians, therapists) and payers (in professional sports: the Verwaltungs-Berufsgenossenschaft, VBG) are involved in the process. If surgical therapy is necessary, preoperative physical functioning is an important prognostic factor regarding the recovery process. In recent years, prehabilitation - i. e. the preoperative improvement or enhancement of bodily functions in order to maintain a patient-specific optimal performance and functional capacity after a planned operation - has become increasingly important.Research question and objective The study primarily examines the effects of prehabilitation using the example of anterior cruciate ligament rupture.Methodology We performed a systematic literature search in PubMed and Embase.Results Of the initial 1,862 articles, 1,858 had to be excluded. Only 2 metaanalyses met the inclusion criteria. The most common reason for exclusion was insufficient publication quality.The studies showed that patients who received prehabilitation had higher muscle strength and better functional status postoperatively and were able to reach their previous level of performance (return to play) earlier. For the physiotherapists, prehabilitation resulted in an additional financial value ((sic)994.85) under the consumption that the remuneration for postoperative rehabilitation was not diminished by it. For the accident insurance carrier (VBG), the shorter recovery period meant cost savings by reducing injury benefits ((sic)14,933 for a saving of 8 weeks) if this did not increase the risk of recurrence or secondary injury.Discussion Prehabilitation showed a positive benefit for all involved. It serves to improve the patient's functional ability and, if necessary, to shorten the period until surgery. For the accident insurance carrier, the low costs of prehabilitation are offset by opportunities for savings. It is important to test the positive effects of prehabilitation identified in this paper in further work on the systematic application of prehabilitation in the German health care system.Conclusion Prehabilitation is a scientifically neglected research topic. The present work (exemplified by the VKBR) presents for the first time its benefits for all parties involved (patients, physiotherapists and insurance carriers). The current study situation is not sufficient to recommend the systematic application of prehabilitation in the German health care system.