The recovery trajectory of anterior cruciate ligament ruptures in randomised controlled trials: A systematic review and meta-analysis of operative and nonoperative treatments.

Abstract

The purpose of this research was to understand the trajectory of recovery following anterior cruciate ligament (ACL) reconstruction compared to nonoperative treatments. A systematic review and meta-analysis approach was used to evaluate randomised controlled trials (RCTs). A comprehensive search was conducted on databases including Medline, Embase, Web of Science and The Cochrane Central Register of Controlled Trials up until 18 May 2023. The study focused on full-text RCTs involving patients with partial or complete ACL tears. Included were studies focusing on patients undergoing ACL reconstruction or nonoperative care. The primary outcome was characterising the effects of treatments and tracking changes in International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) outcomes over time. The secondary outcome was characterising and tracking the changes of the knee injury and osteoarthritis outcome score subscales, ACL-quality-of-life questionnaire, Lysholm, Tegner and CKRS scores. A total of 84 RCTs were included. The pooled standardised mean changes for the IKDC compared with baseline were: 2.0 (95% confidence interval [CI]: 0.3-3.6) at 3 months, 2.2 (95% CI: 0.9-3.6) at 6 months, 2.2 (95% CI: 0.8-3.6) at 12 months and 2.3 (95% CI: 1.3-3.4) at 24 months. Graphs illustrating IKDC scores over time further emphasise these findings, showing a sustained improvement over time to 12 months, with a plateauing of scores past this time point. Our secondary outcome patient-reported outcome measures (PROMs) also showed a similar pattern with scores plateauing at the 12-months mark. Our findings suggest that the IKDC score and other PROMs are effective for tracking recovery up to 12 months. Other PROMs show pain and daily activities generally recover within 6 months, and quality of life improves up to 12 months, but PROMs show minimal improvement beyond this period. This inconsistency with a return sport period indicates that PROMs may lack the sensitivity required to assess this aspect of recovery accurately. Level I.