The following text is summarized from personal experience over the years, and may not be consistent or even conflicting with the views of other doctors, so the viewer needs to consider it carefully and decide whether to accept it according to the actual situation. When many patients have serious dysfunction and find it difficult to recover, they are often confused as to why, with the same injury and similar physique, some people recover so smoothly, almost effortlessly and without pain, while they are in pain but cannot take a step forward. In fact, there are many possible explanations for this problem, excluding congenital personal physical problems, the degree of injury suffered and other problems that we are unable to solve, here is only to talk about the factors that we have the possibility to sway – preoperative function. Whether or not we have a reasonable concept of preoperative rehabilitation is an important indicator of whether or not the whole concept of rehabilitation is advanced. It is not enough to look at the surgery itself or postoperative rehabilitation; sometimes, a reasonable and effective preoperative rehabilitation may have a decisive impact on the whole process of rehabilitation treatment of sports system injuries. It is like the old saying to look at a child’s growth: “At the age of three, look at the age of seven”. In the same way, the preoperative status of a patient can predict whether the postoperative rehabilitation process is smooth and the prognosis is ideal, which shows the importance of preoperative rehabilitation. After talking about preoperative status and preoperative rehabilitation, what kind of status is considered good preoperative status, and what is considered reasonable and effective preoperative rehabilitation? For limbs, the basic functions are: joint mobility, swelling, pain, strength, proprioception, etc. In the postoperative rehabilitation process, the most significant and obvious dysfunction is in joint mobility, which is often referred to as flexibility. As the most basic function, this is the most important issue to be addressed before surgery. In practice, it is often seen that some patients choose to undergo surgery as soon as possible for the sake of saving time and shortening the course of the disease, when the function is limited and the swelling has not yet subsided. Often, however, such a hasty approach, especially in cases of cruciate ligament injuries of the knee, rotator cuff injuries of the shoulder, and glenoid labrum injuries – results in stubborn postoperative dysfunction, which instead prolongs the course of the disease and greatly increases the pain and effort in all aspects of the treatment process. What is going on here? In the case of joint (ligament, intra-articular cartilage, articular cartilage and other appendages) injuries, the injury is followed by massive bleeding inside and outside the joint cavity, joint swelling, peri-articular tissue edema (hematoma), pain, and other symptoms, and because of the steep increase in pressure inside and outside the joint and the stimulation of severe pain, the joint movement is impaired. After a period of protective braking (brace braking or no brace braking), the tendency to bleed is relieved, but due to the presence of fibroblasts, the blood and inflammatory secretions that accumulate inside and outside the joint can act like glue and stick together the layers of tissue that should have the ability to move, leading to a further increase in dysfunction. If you undergo surgery at such a time, combined with the inevitable fresh bleeding during surgery, the stimulation of the trauma will remobilize the activity of the fibroblasts, leading to the further development of fibrous adhesions, which will eventually produce stubborn dysfunction until you end up with a lifelong regret. In order to avoid this, I personally recommend, especially in cases of the common injuries described in the previous paragraphs, that it is best to recondition the joint to near or even full normal function through braking and recuperation before considering surgery. In this way, the process of postoperative rehabilitation may be greatly advanced, and the dramatic reduction in postoperative rehabilitation time and pain will certainly have a tremendous positive effect on the economic, energy, and emotional costs. Of course, the rehabilitation of preoperative joint mobility is not unconditional. For actual cases such as recurrent joint interlocking, impaired mobility due to bony blockage caused by structural damage to the joint, unstable fractures involving the peri-articular area as well as the intra-articular area, and severe nerve and vascular damage, it is still recommended to operate as soon as possible to avoid delaying treatment and causing more damage to the joint. Swelling is also an important factor leading to dysfunction, the general principles of which are described in the above paragraphs and will not be repeated here. The ideal preoperative state is one in which “complete swelling” is also an important condition. After a period of protective braking, the acute trauma period has passed, the bleeding tendency has been suppressed, and since the joint has not yet undergone surgery, there are no fixations inside or outside the joint, and almost all physical therapies can be tried, there are various options for swelling reduction, which creates better objective conditions for accelerated swelling reduction. While the swelling is being reduced, special attention should also be paid to the protection of the traumatized joint to prevent swelling caused by excessive activity or repetition of activities in inappropriate positions, which also maintains good tissue conditions for surgery. If the ideal level of swelling reduction is achieved before undergoing surgery, it is also a great boost to the postoperative rehabilitation process. The protective effect of muscle strength on the joint needs no elaboration, and since it is not advisable to rush surgery after braking, a more comprehensive protection of the damaged joint is needed. Starting from the acute trauma period, in order to maintain the muscle strength around the damaged joint as much as possible, basic subjects such as tensing, straight leg raising, resisted knee extension, resisted knee flexion, and static squatting should be carried out in a safe framework. A safe framework is one that does not cause an aggravation of the injury. It should be said that the vast majority of sites, types and degrees of injury can be sought out and can be trained to maintain muscle function at as relatively ideal a level as possible. A well-developed muscle strength before surgery not only effectively strengthens the protection of the joint, but also greatly enhances the starting point of postoperative rehabilitation, in addition to avoiding the occurrence of postoperative muscle “disuse”. The training of proprioception is difficult and dangerous, so if the injury situation does not allow it, it can be suspended. In fact, ideal muscle strength is an important component of proprioception, and for most patients, it is more important to build as much strength as possible through preoperative rehabilitation. Adequate possession of the basic functions described above can be considered as having the ideal preoperative state, but this is still not enough. Before surgery, it is also important to have a clear understanding of the correct use of protective supports (crutches, splints, knee pads, triangular scarves, etc.); to fully prepare for the postoperative rehabilitation plan; to be psychologically prepared for the difficulties in the postoperative rehabilitation process; and to control even the habit of smoking and alcohol in advance (alcohol and nicotine have a hindering effect on the repair of injuries). Be prepared, these simple tasks are insignificant, but very important for post-operative function! Once you have done all of the above, you can step down and wait for the hospital admission notice. Again, do not think that pre-operative rehabilitation is a waste of time and will affect your work. Years of work experience shows that a reasonable preoperative rehabilitation of 2-3 months may advance the postoperative rehabilitation process by more than half a year! Sometimes some patients may even find that through scientific and effective preoperative rehabilitation that most of the functions are restored and the damage no longer seriously affects daily life, so that preoperative rehabilitation can be considered as an effective conservative treatment and eventually help this part of patients with excellent tissue conditions to avoid the pain of a knife. In addition, from personal observation: for combined knee injuries (cruciate ligament combined with lateral collateral ligament and meniscus injuries), most patients who have all their problems resolved in a single surgery will have difficulty in post-operative rehabilitation due to excessive surgical trauma. If necessary and available, the collateral ligament can be repaired as soon as possible after the injury, and after about 3 months of full functional exercise, the cruciate ligament and meniscus can be repaired again.