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Meta-Analysis
. 2021 Dec;13(1_suppl):1658S-1670S.
doi: 10.1177/19476035211046041.

Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis-A Meta-Analysis

Marco Cuzzolin  1 , Davide Previtali  1 , Stefano Zaffagnini  2 , Luca Deabate  1 , Christian Candrian  1   3 , Giuseppe Filardo  1   3   4
Affiliations
Meta-Analysis

Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis-A Meta-Analysis

Marco Cuzzolin et al. Cartilage. 2021 Dec.

Abstract

Objectives: The impact of anterior cruciate ligament (ACL) reconstruction on knee osteoarthritis (OA) is still unclear. The aim of the current meta-analysis was to compare surgical treatment versus nonoperative management of ACL tears to assess the impact of these approaches on knee OA development at a 5 and 10 years of follow-up.

Design: A meta-analysis was performed after a systematic literature search (May 2021) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Both randomized and nonrandomized comparative studies with more than 5 years of follow-up were selected. Influence of the treatment was assessed in terms of knee OA development, subjective and objective clinical results, activity level, and risk of further surgeries. Risk of bias and quality of evidence were assessed following the Cochrane guidelines.

Results: Twelve studies matched the inclusion criteria, for a total of 1,004 patients. Level of evidence was rated low to very low. No difference was documented in terms of knee OA development, Tegner score, subjective International Knee Documentation Committee (IKDC), and Lysholm scores. A significant difference favoring the surgical treatment in comparison with a nonsurgical approach was observed in terms of objective IKDC score (P = 0.03) and risk of secondary meniscectomy (P < 0.0001). The level of evidence was considered very low for subjective IKDC, low for knee OA development, objective IKDC, number of secondary meniscectomies, and Lysholm score, and moderate for post-op Tegner score.

Conclusions: The meta-analysis did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with a nonoperative treatment. Moreover, no differences were reported for subjective results and activity level at 5 and 10 years of follow-up. On the contrary, patients who underwent surgical treatment of their ACL tear presented important clinical findings in terms of better objective knee function and a lower rate of secondary meniscectomies when compared with conservatively managed patents.Protocol Registration: CRD420191156483 (PROSPERO).

Keywords: ACL reconstruction; anterior cruciate ligament; conservative treatment; osteoarthritis; radiologic evaluation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Cuzzolin, Dr. Deabate, Professor Filardo, and Dr. Previtali declare they have no conflict of interest. Professor Zaffagnini reports personal fees from I+ SRL, grants from Fidia Farmaceutici SPA, CartiHeal ltd, IGEA Clinical Biophysics, BIOMET, and Kensey Nash, outside the submitted work. In addition, Professor Zaffagnini has a Springer patent with royalties paid. Professor Candrian reports grants from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG, outside the submitted work.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of the article selection process. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analysis.
Figure 2.
Figure 2.
Forest plots for knee osteoarthritis rates and IKDC subjective and objective evaluation forms. IKDC = International Knee Documentation Committee; CI = confidence interval.
Figure 3.
Figure 3.
Forest plots for Lysholm and Tegner scores and risk of secondary meniscectomies. CI = confidence interval.
Figure 4.
Figure 4.
Risk of Bias of Included Randomized Controlled Trial. Green (formula image) stands for “low risk”; yellow (formula image) for “moderate risk”; red for (formula image) “high risk.”
Figure 5.
Figure 5.
Risk of Bias of Included Nonrandomized Controlled Trial. Green (formula image) stands for “low risk”; yellow (formula image) for “moderate risk”; red for (formula image) “high risk.”
See this image and copyright information in PMC

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