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

Teodor Lien-Iversen, Daniel Barklin Morgan, Carsten Jensen, May Arna Risberg, Lars Engebretsen, Bjarke Viberg*

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

Abstract

Objective: We compared long-term follow-up from surgical versus non-surgical treatment of ACL rupture regarding radiographic knee osteoarthritis (OA), secondary surgery, laxity and patient-reported outcome measures (PROMs). Design: Systematic review and meta-analysis. Data sources: Embase, MEDLINE, CINAHL and the Cochrane Library databases. Eligibility criteria for selecting studies: Studies directly comparing the minimally invasive surgical (arthroscopy or miniarthrotomy) and non-surgical treatment of ACL rupture with at least 10 years of follow-up in adult patients were included. Results: Five studies met the eligibility criteria. A meta-analysis revealed a higher risk of radiographic knee OA and a lower risk of secondary meniscal surgery for patients in the surgical group. The risk of graft rupture/secondary ACL revision and secondary ACL reconstruction was equal in the surgical and non-surgical groups. Knee laxity was lower among patients in the surgical group in four studies. No difference was found in the PROMs (ie, International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores). Conclusion: The risk of radiographic knee OA was higher, but the risk of secondary meniscal injury was lower 10 years after surgical treatment of ACL rupture. The risk of graft rupture/secondary ACL revision or secondary reconstruction was unrelated to treatment type. The degree of knee laxity was reduced after surgical treatment in comparison with non-surgical treatment, while PROMs were similar. However, due to the methodological challenges highlighted in this systematic review, these findings must be interpreted with caution. PROSPERO registration number: CRD42019119468

Original languageEnglish
Article number100765
JournalBritish Journal of Sports Medicine
ISSN0306-3674
DOIs
Publication statusE-pub ahead of print - 15. Nov 2019

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Knee Osteoarthritis
Meta-Analysis
Rupture
Wounds and Injuries
Knee
Knee Injuries
Information Storage and Retrieval
MEDLINE
Documentation
Libraries
Databases

Keywords

  • ACL
  • knee surgery

Cite this

@article{7be65f5ef77a4634a8c1851fc8871ce2,
title = "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",
abstract = "Objective: We compared long-term follow-up from surgical versus non-surgical treatment of ACL rupture regarding radiographic knee osteoarthritis (OA), secondary surgery, laxity and patient-reported outcome measures (PROMs). Design: Systematic review and meta-analysis. Data sources: Embase, MEDLINE, CINAHL and the Cochrane Library databases. Eligibility criteria for selecting studies: Studies directly comparing the minimally invasive surgical (arthroscopy or miniarthrotomy) and non-surgical treatment of ACL rupture with at least 10 years of follow-up in adult patients were included. Results: Five studies met the eligibility criteria. A meta-analysis revealed a higher risk of radiographic knee OA and a lower risk of secondary meniscal surgery for patients in the surgical group. The risk of graft rupture/secondary ACL revision and secondary ACL reconstruction was equal in the surgical and non-surgical groups. Knee laxity was lower among patients in the surgical group in four studies. No difference was found in the PROMs (ie, International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores). Conclusion: The risk of radiographic knee OA was higher, but the risk of secondary meniscal injury was lower 10 years after surgical treatment of ACL rupture. The risk of graft rupture/secondary ACL revision or secondary reconstruction was unrelated to treatment type. The degree of knee laxity was reduced after surgical treatment in comparison with non-surgical treatment, while PROMs were similar. However, due to the methodological challenges highlighted in this systematic review, these findings must be interpreted with caution. PROSPERO registration number: CRD42019119468",
keywords = "ACL, knee surgery",
author = "Teodor Lien-Iversen and Morgan, {Daniel Barklin} and Carsten Jensen and Risberg, {May Arna} and Lars Engebretsen and Bjarke Viberg",
year = "2019",
month = "11",
day = "15",
doi = "10.1136/bjsports-2019-100765",
language = "English",
journal = "British Journal of Sports Medicine",
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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. / Lien-Iversen, Teodor; Morgan, Daniel Barklin; Jensen, Carsten; Risberg, May Arna; Engebretsen, Lars; Viberg, Bjarke.

In: British Journal of Sports Medicine, 15.11.2019.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - 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

AU - Lien-Iversen, Teodor

AU - Morgan, Daniel Barklin

AU - Jensen, Carsten

AU - Risberg, May Arna

AU - Engebretsen, Lars

AU - Viberg, Bjarke

PY - 2019/11/15

Y1 - 2019/11/15

N2 - Objective: We compared long-term follow-up from surgical versus non-surgical treatment of ACL rupture regarding radiographic knee osteoarthritis (OA), secondary surgery, laxity and patient-reported outcome measures (PROMs). Design: Systematic review and meta-analysis. Data sources: Embase, MEDLINE, CINAHL and the Cochrane Library databases. Eligibility criteria for selecting studies: Studies directly comparing the minimally invasive surgical (arthroscopy or miniarthrotomy) and non-surgical treatment of ACL rupture with at least 10 years of follow-up in adult patients were included. Results: Five studies met the eligibility criteria. A meta-analysis revealed a higher risk of radiographic knee OA and a lower risk of secondary meniscal surgery for patients in the surgical group. The risk of graft rupture/secondary ACL revision and secondary ACL reconstruction was equal in the surgical and non-surgical groups. Knee laxity was lower among patients in the surgical group in four studies. No difference was found in the PROMs (ie, International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores). Conclusion: The risk of radiographic knee OA was higher, but the risk of secondary meniscal injury was lower 10 years after surgical treatment of ACL rupture. The risk of graft rupture/secondary ACL revision or secondary reconstruction was unrelated to treatment type. The degree of knee laxity was reduced after surgical treatment in comparison with non-surgical treatment, while PROMs were similar. However, due to the methodological challenges highlighted in this systematic review, these findings must be interpreted with caution. PROSPERO registration number: CRD42019119468

AB - Objective: We compared long-term follow-up from surgical versus non-surgical treatment of ACL rupture regarding radiographic knee osteoarthritis (OA), secondary surgery, laxity and patient-reported outcome measures (PROMs). Design: Systematic review and meta-analysis. Data sources: Embase, MEDLINE, CINAHL and the Cochrane Library databases. Eligibility criteria for selecting studies: Studies directly comparing the minimally invasive surgical (arthroscopy or miniarthrotomy) and non-surgical treatment of ACL rupture with at least 10 years of follow-up in adult patients were included. Results: Five studies met the eligibility criteria. A meta-analysis revealed a higher risk of radiographic knee OA and a lower risk of secondary meniscal surgery for patients in the surgical group. The risk of graft rupture/secondary ACL revision and secondary ACL reconstruction was equal in the surgical and non-surgical groups. Knee laxity was lower among patients in the surgical group in four studies. No difference was found in the PROMs (ie, International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores). Conclusion: The risk of radiographic knee OA was higher, but the risk of secondary meniscal injury was lower 10 years after surgical treatment of ACL rupture. The risk of graft rupture/secondary ACL revision or secondary reconstruction was unrelated to treatment type. The degree of knee laxity was reduced after surgical treatment in comparison with non-surgical treatment, while PROMs were similar. However, due to the methodological challenges highlighted in this systematic review, these findings must be interpreted with caution. PROSPERO registration number: CRD42019119468

KW - ACL

KW - knee surgery

U2 - 10.1136/bjsports-2019-100765

DO - 10.1136/bjsports-2019-100765

M3 - Review

C2 - 31732650

AN - SCOPUS:85075179975

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

SN - 0306-3674

M1 - 100765

ER -