TY - JOUR
T1 - Anterior cruciate ligament reconstruction results in better patient reported outcomes but has no advantage for activities of daily living or the subsequent development of osteoarthritis. A systematic review and meta-analysis
AU - Hohmann, Erik
AU - Tetsworth, Kevin
AU - Glatt, Vaida
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Surgical reconstruction of ACL injuries is a common strategy but superiority over conservative treatment has not been established. The aim was to perform a systematic review and meta-analysis comparing outcomes between operative and non-operative treatment of ACL injuries. Methods: Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1–3 studies from 2000 to 2021. Patient reported outcome scores and objective measures for knee stability were included. Risk of bias was assessed using the Cochrane Collaboration's tools. GRADE was used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. Results: Twelve studies were included in the analysis. All studies had a high risk of bias and were of low quality. The pooled estimates for IKDC (p = 0.040) favored surgical treatment. There were significant differences for activities of daily living (p = 0.0001) in favor of conservative treatment. There were significant differences for knee stability (p = 0.016) in favor of surgical treatment. The risk of osteoarthritis was not significantly different between the two treatment modalities (p = 0.219). Patients undergoing surgery had a 57% higher risk of osteoarthritis. Conclusion: ACL reconstruction results in a significantly more stable knee with superior clinical and functional outcomes. However, these advantages over conservative treatment were not observed for routine activities of daily living, and subjective patient perceived outcomes favor nonsurgical treatment. Surgical treatment did not reduce the risk of later developing osteoarthritis. Regardless, due to low study quality and high risk of bias, these findings must be interpreted with caution.
AB - Background: Surgical reconstruction of ACL injuries is a common strategy but superiority over conservative treatment has not been established. The aim was to perform a systematic review and meta-analysis comparing outcomes between operative and non-operative treatment of ACL injuries. Methods: Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1–3 studies from 2000 to 2021. Patient reported outcome scores and objective measures for knee stability were included. Risk of bias was assessed using the Cochrane Collaboration's tools. GRADE was used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. Results: Twelve studies were included in the analysis. All studies had a high risk of bias and were of low quality. The pooled estimates for IKDC (p = 0.040) favored surgical treatment. There were significant differences for activities of daily living (p = 0.0001) in favor of conservative treatment. There were significant differences for knee stability (p = 0.016) in favor of surgical treatment. The risk of osteoarthritis was not significantly different between the two treatment modalities (p = 0.219). Patients undergoing surgery had a 57% higher risk of osteoarthritis. Conclusion: ACL reconstruction results in a significantly more stable knee with superior clinical and functional outcomes. However, these advantages over conservative treatment were not observed for routine activities of daily living, and subjective patient perceived outcomes favor nonsurgical treatment. Surgical treatment did not reduce the risk of later developing osteoarthritis. Regardless, due to low study quality and high risk of bias, these findings must be interpreted with caution.
KW - Anterior cruciate ligament injury
KW - Anterior cruciate ligament reconstruction
KW - Clinical outcomes
KW - Conservative treatment
KW - Surgical treatment
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U2 - 10.1016/j.knee.2022.12.018
DO - 10.1016/j.knee.2022.12.018
M3 - Review article
C2 - 36682098
AN - SCOPUS:85146538738
SN - 0968-0160
VL - 41
SP - 137
EP - 149
JO - Knee
JF - Knee
ER -