Return to sport and clinical outcomes after arthroscopic anterior cruciate ligament repair versus reconstruction: A systematic review and meta-analysis.
meta_analysis · Level I
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- Also identified by DOI 10.1002/ksa.70233.
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Abstract
To compare return to sport (RTS), time to RTS, postoperative activity levels, failure rates and anterior laxity between anterior cruciate ligament (ACL) repair and reconstruction (ACLR) through a systematic review and meta-analysis of comparative studies. A systematic literature search was performed in November 2024 across PubMed, MEDLINE, Scopus and Google Scholar following PRISMA guidelines. Studies comparing ACL repair and reconstruction with a minimum 24-month follow-up and reporting RTS outcomes were included. Data on RTS rates and timing, Tegner Activity Score (TAS), ACL-Return to Sport after Injury scale (ACL-RSI), anterior tibial translation and failure rates were extracted. Meta-analyses were conducted using Review Manager (RevMan) 5.4. Odds ratios (ORs) and mean differences (MDs) were calculated using fixed or random-effects models based on heterogeneity. Nine studies (two randomized controlled trials [RCTs] and seven cohort studies), including 819 patients (352 repairs and 467 reconstructions), met the inclusion criteria. The RTS rate was significantly higher in the ACL repair group (75.3%) than in the ACLR group (66.5%) (OR 0.61; 95% confidence interval [CI]: 0.42-0.88; p = 0.009; I<sup>2</sup> = 0%). Time to RTS was 1.38 months shorter for ACL repair (MD -1.38; 95% CI: -1.76 to -1.00; p < 0.00001; I<sup>2</sup> = 73%). No significant differences were found in postoperative TAS or anterior laxity. However, ACL repair had a higher failure rate (9.8% vs. 3.3%; OR 4.00; 95% CI: 2.41-6.63; p = 0.0001; I<sup>2</sup> = 60%). ACL-RSI scores were slightly higher after reconstruction (MD 3.96; 95% CI: 0.49-7.44; p = 0.03; I<sup>2</sup> = 79%). Modern ACL repair results in a statistically significant earlier RTS compared to ACLR. However, this difference must be correlated with its clinical relevance, as postoperative activity levels and anterior knee laxity are similar between the two procedures. In addition, the risk of failure is approximately four times higher after ACL repair, and psychological readiness may be superior after ACLR. Level III.