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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
  1. Teodor Lien-Iversen1,2,
  2. Daniel Barklin Morgan1,2,
  3. Carsten Jensen1,2,
  4. May Arna Risberg3,4,
  5. Lars Engebretsen3,4,5,
  6. Bjarke Viberg1,2
  1. 1 Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
  2. 2 Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
  3. 3 Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
  5. 5 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Bjarke Viberg, Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital—University Hospital of Southern Denmark, Kolding 6000, Denmark; bjarke.viberg{at}


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

  • ACL
  • knee surgery

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  • Contributors BV conceived the project, while BV and CJ led the design (intervention selection, patient population, data management and statistical analyses). TL-I, DBM, MAR and LE contributed to the design. TL-I and DBM performed the literature search, extraction of data, quality assessment of studies and synthesis of the results, and drafted the manuscript. All the authors provided critical intellectual input to the manuscript and read and approved the final version of the manuscript, agreeing to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BV reports personal fees for lectures from Zimmer Biomet and Osmedic Swemac outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.