2023 ISAKOS Biennial Congress ePoster
Non-Operative Treatment is an Excellent Option for Isolated Anterior Cruciate Ligament Injuries: a Systematic Review and Meta-Analysis
Robert de Jonge, MD, Budapest HUNGARY
Miklos Mate, MD, Budapest, Pest HUNGARY
Norbert Kovacs, MD, Budapest HUNGARY
Marcell Imrei, MD, , Budapest HUNGARY
Karoly Pap, MD, PhD, Budapest, Hungary HUNGARY
Gergely Agocs, PhD, Budapest HUNGARY
Peter Hegyi, Prof., Budapest HUNGARY
Gergely Pánics, PhD, Budapest HUNGARY
Centre for Translational Medicine, Semmelweis University, Budapest, HUNGARY
FDA Status Not Applicable
Summary
The purpose of our study was to evaluate the available data of the current literature investigating isolated ACL ruptures treated with either surgical reconstruction or conservative methods and comparing them by functional and radiological outcomes.
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Abstract
Background
Anterior cruciate ligament (ACL) tear is one of the most common knee injuries, which is a risk factor of early onset of osteoarthritis (OA). Gold standard treatment is surgical reconstruction and conservative treatment is reserved as an alternative. Despite ACL injuries being well studied, until today we still do not understand which option is better to prevent knee OA. Our aim was to investigate the patients with isolated ACL ruptures treated with either surgical reconstruction or conservative methods and compare them by functional and radiological outcomes.
Materials And Methods
This review was registered on PROSPERO (CRD42021285901). We systematically searched three databases until 25 October, for comparing ACL reconstruction with conservative treatment. Main outcomes were radiologic signs and function parameters. Meta-analytical calculations for mean differences (MDs) and odds ratios (ORs) were performed with the common-effects model and interpreted with 95% confidence intervals (CIs).
Results
A total of 5 studies were included in the quantitative synthesis. Conservatively treated knees have lower odds to develop radiological signs of OA (OR=1.84 [CI: 0.90; 3.75]) despite surgically reconstructed ones have better stability thru arthrometry measures (MD=-2.44 [CI: -3.21; -0.66]) and not significantly better Lysholm scores (MD=2.88 [CI: -1.09; 6.85]). In the qualitative synthesis, there were tendencies showing surgical reconstruction being protective for subsequent injuries, but not being superior regarding returning to previous activity levels or various functional tests.
Conclusions
Based on our findings there is no certain evidence that reconstruction of an isolated ACL injury is superior compared to conservative treatment, in terms of subjective outcome, protection of osteoarthritic changes and return to play, despite passive stability being better for reconstructed knees. Therefore, non-operative treatment should be considered before deciding for surgical intervention.