Abstract
Aims
The purpose of this study was to determine the optimal clinical and cost-effective
strategy for managing people following ACL rupture.
Methods
A systematic review of the published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, psycINFO
and the Cochrane Library) and unpublished literature (OpenGrey, the WHO International
Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research
Register Archive) was conducted on April 2013. All randomised and non-randomised controlled
trials evaluating clinical or health economic outcomes of isolated ligament reconstruction
versus non-surgical management following ACL rupture were included. Methodological
quality was assessed using the PEDro appraisal tool. When appropriate, meta-analysis
was conducted to pool data.
Results
From a total of 943 citations, sixteen studies met the eligibility criteria. These
included 1397 participants, 825 who received ACL reconstruction versus 592 who were
managed non-surgically. The methodological quality of the literature was poor. The
findings indicated that whilst reconstructed ACL offers significantly greater objective
tibiofemoral stability (p < 0.001), there appears limited evidence to suggest a superiority between reconstruction
versus non-surgical management in functional outcomes. There was a small difference
between the management strategies in respect to the development of osteoarthritis
during the initial 20 years following index management strategy (Odds Ratio 1.56; p = 0.05).
Conclusions
The current literature is insufficient to base clinical decision-making with respect
to treatment opinions for people following ACL rupture. Whilst based on a poor evidence,
the current evidence would indicate that people following ACL rupture should receive
non-operative interventions before surgical intervention is considered.
Keywords
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Article info
Publication history
Published online: November 14, 2013
Accepted:
October 14,
2013
Received in revised form:
August 28,
2013
Received:
April 30,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
