The efficacy of anterior cruciate ligament reconstruction and rehabilitation compared to conservative management for reducing the incidence of post-traumatic osteoarthritis following anterior cruciate ligament injury: A systematic review

Abstract

Anterior cruciate ligament (ACL) injury is a risk factor for developing post-traumatic osteoarthritis (PTOA). The burden of ACL injuries and PTOA is considerable and predicted to increase if there is no change in their management. The efficacy of different ACL rehabilitation interventions in reducing the incidence of PTOA is unknown. This systematic review aimed to identify, synthesise, and critique research findings that evaluated the effectiveness of anterior cruciate ligament reconstruction (ACLR) plus rehabilitation compared to rehabilitation alone on the incidence of PTOA following ACL injury. A quality critique of the selected studies was undertaken using a modified Downs and Black appraisal tool. Data were extracted and analysed to answer the research question: What is the effect of ACL reconstruction and rehabilitation compared to conservative management on the incidence of PTOA after ACL injury? Six good-quality articles were retained for final review. Five studies compared the effect of surgical and non-surgical management of ACL injuries on developing PTOA. One study investigated the impact of different ACL rehabilitation protocols on the development of PTOA. The incidence of PTOA following ACL injury was comparable regardless of the surgical or non-surgical intervention and rehabilitation compared in each study. Further high-quality studies are needed to inform ACL injury management to reduce the impact of PTOA following ACL injury.