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Review
. 2024 Nov 29;16(11):e74718.
doi: 10.7759/cureus.74718. eCollection 2024 Nov.

Exploring the Efficacy of Conservative Management Versus Surgical Intervention in Anterior Cruciate Ligament (ACL) Injuries: Insights Into Reinjury Rates, Quality of Life, and Long-Term Outcomes

Daniel E Onobun  1 , Chijioke Orji  2 , Ethel O Ojo  1 , Ajibola A Adebisi  3 , Kenechukwu Igbokwe  4 , Rajinder Sehmar  1 , Reginald Ononye  5 , Olgun Aksaray  6 , Stephen Oputa  7 , Chidera S Nmereole  8
Affiliations
Review

Exploring the Efficacy of Conservative Management Versus Surgical Intervention in Anterior Cruciate Ligament (ACL) Injuries: Insights Into Reinjury Rates, Quality of Life, and Long-Term Outcomes

Daniel E Onobun et al. Cureus. .

Abstract

This systematic review and meta-analysis evaluate the comparative outcomes of conservative management versus surgical intervention for anterior cruciate ligament (ACL) injuries. A comprehensive search of PubMed, Cochrane Library, Web of Science, SPORTDiscus, and Google Scholar focused on studies published between 2010 and 2024. Data synthesis employed both thematic analysis for qualitative data and meta-analysis for quantitative outcomes. Key findings indicate that conservative management yields lower reinjury rates and higher quality of life (QoL) scores (64.6 vs. 57.1) compared to surgical intervention, though differences were not statistically significant (p = 0.1483). Both strategies demonstrated comparable return-to-sport (RTS) rates. Meta-regression analysis revealed that longer follow-up durations positively influenced outcomes (p = 0.0288). The average complication rate was 49.83 per study (CI: 25.84-73.82), underscoring significant risks associated with both approaches. Conservative management shows promise as an initial treatment option for certain ACL injuries, particularly regarding reinjury prevention and QoL improvements. However, surgical intervention remains crucial for specific cases requiring enhanced knee stability. The results underscore the importance of individualized treatment planning, long-term follow-up, and further standardization of outcome measures in future research.

Keywords: acl injuries; conservative management; long-term outcomes; meta-analysis; quality of life; reinjury rates; return-to-sport; surgical intervention.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart
Figure 2
Figure 2. Funnel plot for publication bias
Figure 3
Figure 3. Forest plot of complications associated with ACL treatment
Refs. [2,12-24] ACL - anterior cruciate ligament
See this image and copyright information in PMC

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