Introduction <p>Strength and balance are essential components in the rehabilitation process following anterior cruciate ligament (ACL) injury. Engaging in pre-rehabilitation before surgery may substantially enhance post-operative recovery outcomes. This study aimed to evaluate the effectiveness of a combined pre-rehabilitation and post-surgical rehabilitation approach compared with standard rehabilitation alone in athletes recovering from ACL injury.</p> Methods <p>This single-blind randomized controlled trial included 30 male athletes aged 18–25 years with ACL injuries. Participants were randomly assigned to an intervention group (pre-rehabilitation + rehabilitation; <i>n</i> = 15) or a control group (rehabilitation only; <i>n</i> = 15). The intervention group completed a 4-week preoperative exercise program consisting of isometric muscle-setting exercises performed three times per week. Following ACL reconstruction, both groups participated in an identical standardized 10-week rehabilitation protocol divided into three progressive phases. Outcome measures included static balance, dynamic balance, and muscle strength.</p> Results <p>Both pre-rehabilitation + rehabilitation and rehabilitation alone significantly improved balance and strength. However, the combined approach yielded greater improvements in dynamic balance—specifically in anterior–posterior sway under eyes-closed (EC) and eyes-open (EO) conditions (<i>p</i> &lt; 0.001, η² = 0.913)—as well as in static balance for overall postural control (EO; <i>p</i> &lt; 0.001). Moreover, significant gains were observed in both hamstring and quadriceps muscle strength on the injured leg (<i>p</i> &lt; 0.001).</p> Conclusion <p>Incorporating a structured pre-rehabilitation phase prior to surgery significantly enhances balance and muscular recovery following ACL reconstruction compared with rehabilitation alone. Therefore, pre-rehabilitation should be considered an integral component of comprehensive ACL rehabilitation programs.</p>