Editorial Commentary: Limited Preoperative Range of Motion Is Associated With Range of Motion Deficits After Anterior Cruciate Ligament Reconstruction: “If the Knee Is Not Straight, Wait”

Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains under debate. Prolonging time between injury and ACLR risks damaging the meniscus and chondral surface, as well as delays return to play. Early ACLR may be associated with postoperative stiffness or arthrofibrosis. We emphasize that optimal timing for ACLR depends on criterion-based return of knee range of motion and quadriceps strength, not a quantitative temporal period. The length of time is far less important that the quality of prereconstruction care provided. Prereconstruction care includes “prehabilitation,” including prone hangs focusing on optimizing knee range of motion, postinjury effusion resolution, and mentally preparing the patient for postoperative expectations. Defining preoperative criteria for proceeding with surgery is crucial to decrease the risk of arthrofibrosis. Some patients meet these criteria within 2 weeks, whereas others linger to 10 weeks. Reduction in arthrofibrosis requiring surgical intervention is multifactorial and not solely dependent on the length of time between injury and intervention.