Summary

Treatment-dependent differences in prognostic factors for short-term outcomes may support individualized treatment after acute ACL rupture in young active individuals. It should advisable to the patient that the risk of future knee lesions and OA remains relevant, especially if the patient return to high-risk pivoting activity regardless of treatment therapy.

Abstract

Aim

The aim of the present meta-analysis was to analyze the best available literature evidence on this topic, including only studies directly comparing surgical treatment versus conservative management of an ACL tear, on short-term follow-up. To find out multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. We hypothesized that surgical treatment is chondroprotective and also it can provide lower rates of knee OA, while it has better knee function and higher activity levels compared with the conservative management of ACL tears.

Methods

Systematically searched three databases until 1 October, to compare short-term osteoarthritic evolution of ACL injured knees. We compared the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial, and Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial. The main outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, sport/recreation and quality of life (QOL) scores were explored using multivariable linear regression. In the qualitative synthesis we investigated the relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation visits, graft/contralateral ACL rupture, non-ACL surgery and ACL treatment strategy), and we made an MRI grade analysis between 5 different grades on the same (KANON) trial.

Results

In the quantitative synthesis both studies the mean KOOS-QOL scores in the surgical group(39; SD=29,52; 46,2; SD=28,18) are better than in the conservative group. The other four scores do not have significant differences between the two interventions. In the qualitative synthesis, the MRI grades showed that the extension of early cartilage defects was clearly visible and had bigger cartilage changes in the reconstructed group early after surgery up to 3 months compared to 5 years. The systematic review revealed that although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes and it did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with nonoperative treatment.

Conclusions

Treatment-dependent differences in prognostic factors for short-term outcomes may support individualized treatment after acute ACL rupture in young active individuals. Both of the treatment choices improved significantly in knee function. It should advisable to the patient that the risk of future knee lesions and OA remains relevant, especially if the patient return to high-risk pivoting activity regardless of treatment therapy.