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Abstract

Anterior cruciate ligament (ACL) injury is a common musculoskeletal condition that may result in long-term functional limitations. Preoperative strength training (PST) is associated with improved postoperative outcomes following ACL reconstruction (ACLR), yet its clinical implementation remains inconsistent. PURPOSE: To characterize the frequency of PST implementation, physical therapists’ (PTs) perceptions of its importance, and perceived barriers to its use in ACLR care. METHODS: A cross-sectional online survey of licensed U.S. PTs was conducted using snowball sampling. The questionnaire was developed from prior literature, pilot-tested, and refined. Of 221 responses, 42 incomplete or non-consented responses were excluded, yielding 179 analyzed responses. Descriptive statistics were used to summarize responses. RESULTS: Respondents represented 43 states, with 78.2% (140/179) holding a Doctor of Physical Therapy degree. Most strongly agreed PST should be part of standard ACLR care (65.9%, 118/179). Regarding clinical environment, 41.9% (75/179) strongly agreed, and 35.2% (63/179) agreed that preoperative ACL rehabilitation is underutilized. Quadriceps strength was identified as a key determinant of postoperative outcomes by 60.3% of respondents. In practice, 54.2% (97/179) reported prescribing PST twice weekly, and 52.5% (94/179) reported durations of 2–4 weeks. Despite strong agreement on PST importance, implementation varied, indicating a gap between perception and practice. Common barriers included delayed referral, limited time before surgery, and insurance constraints. CONCLUSION: PTs recognize the importance of PST for ACLR but report inconsistent implementation and systemic barriers. These findings suggest a gap between perceived value and clinical use. Results should be interpreted cautiously due to non-random sampling.

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