Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis

Review written by Linda Truong info

Key Points

  1. There are only three randomized controlled trials available that have compared early surgery to rehabilitation after an anterior cruciate ligament (ACL) tear, with only one high-quality RCT published.
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BACKGROUND & OBJECTIVE

There has been an on-going debate about whether surgical or non-surgical management of anterior cruciate ligament (ACL) tears is optimal. While ACL reconstruction (ACLR) is the most common approach to managing ACL tears, is it the best approach? ACLR does not guarantee athletes will have a successful return to sport (RTS) (1) and reinjury risk remains high, with up to 20% sustaining an injury to either the ACL graft or contralateral limb upon RTS (2).

This systematic review and meta-analysis aimed to synthesize high-quality evidence comparing the effectiveness of primary surgical (i.e. ACLR) versus rehabilitation after ACL tears.

Anterior cruciate ligament reconstruction does not guarantee athletes will have a successful return to sport and reinjury risk remains high.
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We must be careful in how we frame treatment options for patients, as some patients with ACL tears will require ACL reconstruction and others will manage well non-surgically.

METHODS

  • This is a living systematic review which means it will be updated every year for a minimum of 6 years. Studies included were randomized controlled trials (RCTs) that compared primary ACLR (of any technique) to any rehabilitation treatment strategy (e.g.
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