The BEAR^® Implant has been adopted by hundreds of surgeons across the U.S. as a new approach to treating anterior cruciate ligament (ACL) tears. The BEAR Implant enables your torn ACL to heal and restores the natural function instead of replacing it with a graft in an ACL reconstruction (ACLR).

If you are preparing for ACL surgery with the BEAR Implant, your surgeon may recommend prehab. These exercises, which are done after injury and before surgery to improve function, can help you prepare for a successful recovery. Read on for answers to four common questions about ACL prehab from physical therapy (PT) experts at a leading orthopedic medical institution.

1. When should ACL prehab begin?

Once you have been diagnosed with an ACL tear and are scheduled for surgery, you should consider visiting a physical therapist as soon as possible to determine a prehab plan for you. Four to six weeks of prehab prior to BEAR Implant surgery may help contribute to improved strength and motion post-op.¹ Be sure to consult with your surgeon beforehand as they may recommend shortening the prehab period. In most states, your insurance will cover a PT visit before surgery.

2. What are the goals of ACL prehab?

The primary goals of prehab include:

• Strengthening the muscles around the injured knee, including the quads and hamstrings
• Increasing range of motion (ROM), working toward full extension of the injured leg
• Increasing blood flow to promote healing
• Reducing the likelihood of injury to your other knee, called a contralateral tear

Prior to surgery, you should work toward restoring full symmetrical extension/hyperextension compared to the uninjured knee. You should also be able to perform a straight leg raise without a lag (zero bend in the knee, indicating good quad function) and demonstrate typical patterns and movements involved in walking or running, called gait mechanics, prior to surgery.

Accomplishing these tasks has been shown to lead to better outcomes.¹ They are also the early post-op goals (usually around 2-4 weeks) for BEAR Implant patients.

3. What types of exercises should ACL prehab include?

Here are a few examples of exercises* that you may perform under the guidance of a PT prior to surgery:

• Full knee extension exercises: Straighten your injured leg while sitting or lying down on your back with your heel on a small rolled up towel. Complete this exercise for 20-30 minutes 3-4x per day.
• Quad exercises: Sitting or lying down with your knee straight, tighten/engage your quad muscle to push your knee flat. Goal should be to achieve 80 percent of quad strength compared to your uninjured knee.
• Hamstring sets: On your back, bend your knee to 90 degrees and push your heel into the surface with mild to moderate pressure, hold for around 6 seconds at a time.
• Straight leg raises: On your back or your stomach, lift your straightened leg as high as possible.
• Other exercises: Heel raises, double leg quarter squats and side lying hip abductions may also be suggested.
• Low-impact cardio: Activities like swimming or elliptical are okay, but do not return to pivoting sports.

These are just a few examples of prehab exercises. Consult with your PT on the best exercises for your prehab plan.

Also be sure to have your PT take strength measurements of your uninjured leg pre-op to get more accurate measurements that will better inform your return to sports and other physical activities.

*If directed by your PT or doctor, use crutches during these exercises to help protect your knee, placing as much weight on your injured knee without increasing pain.

4. What are the benefits of ACL prehab?

Completing prehab sets you up to be more successful in the post-op process not only in your physical strength but also your understanding of typical post-op timelines so that you can set and manage expectations for your recovery.

In addition, some surgeons will not operate on a knee with a large deficit in ROM, so you should work toward achieving ROM within a few degrees of the uninjured leg to ensure that your surgery will be completed on schedule.

If you’re interested in learning more about what to expect post-surgery, download the post-op instructions.

Learn more about the BEAR Implant and find a surgeon

The BEAR Implant is available across the U.S. Learn more about the BEAR Implant or find a surgeon in your area. If you’re a BEAR Implant patient and would like to share your story, click here.

The BEAR Implant from Miach Orthopaedics was approved by the U.S. Food and Drug Administration in December 2020. It is indicated for adults, adolescents and children with a complete or partial rupture of the ACL, as confirmed by MRI. Patients must have an ACL stump attached to the tibia to construct the repair. Children with open physes must have sufficient bone in the femoral and tibial epiphyses on either side of the intended tunnel locations to avoid disruption of the growth plates.

It is important to follow the BEAR Implant physical therapy program. Your surgeon can explain the program details.

Be sure to discuss your individual symptoms, diagnosis and treatment with your surgeon. The BEAR Implant has the same potential medical/surgical complications as other orthopedic surgical procedures, including ACL reconstruction. These include the risk of re-tear, infection, knee pain, meniscus injury and limited range of motion.

Visit www.miachortho.com for complete product information, including Instructions for Use.

ML-1218 Rev A 11/2024

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¹ Cunha J, Solomon DJ. ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e65-e69. doi: 10.1016/j.asmr.2021.11.001. PMID: 35141537; PMCID: PMC8811524. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811524/.