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ACL surgery versus non-surgery on knee osteoarthritis, meniscal injury and knee laxity

Summary of a review of the effects of surgery after anterior cruciate ligament (ACL) rupture on knee osteoarthritis, meniscal injury, and other complications with at least 10 years follow-up.

Who

371 persons (164 surgically managed, 207 non-surgically managed) (Greece, Germany, Switzerland, Sweden, the Netherlands).

Surgery: minimally invasive (arthroscopy, miniarthrotomy).

Design

Systematic review and meta-analysis of 5 studies (2 prospective, 3 retrospective studies; one study with high-level athletes).

Follow-up between 10 and 20 years.

Outcome measures/tests

  • severity of radiographic knee osteoarthritis (Kellgren and Lawrence system, IKDC grading, OARSI atlas)
  • secondary meniscotomy, ACL revision
  • knee laxity (KT-1000 arthrometer)

Main results

  • The risk of radiographic osteoarthritis was higher in the surgical groups (RR 1.42 95%CI: 1.09, 1.85) than non-surgical groups.
  • Secondary meniscectomy was lower in surgical treatment groups (RR 0.34 95%CI: 0.20, 0.58). But graft rupture or secondary ACL revision were independent of treatment (RR 0.90 95%CI: 0.49, 1.66).
  • Knee laxity was significantly lower in surgical groups in 4 out of 5 studies.

Take home message

For a clinician
Risk of radiographic osteoarthritis was higher but knee laxity was lower in patients managed surgically after ACL rupture.
For a parent
Persons with surgically managed ACL ruptures had more osteoartritis (painful joint condition) but less laxity in their knee (more stable knee).
For an athlete
Statistically, persons who had a surgery after tearing their ACL had more osteoartritis (painful joint condition) but less laxity in their knee (more stable knee).

Original article

Lien-Iversen T, Morgan DB, Jensen C, Risberg MA, Engebretsen L, Viberg B. Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis. British journal of sports medicine. 2020 May 1;54(10):592-8.

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